Provider Demographics
NPI:1609971563
Name:WAMPLER, JENNIFER (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 41ST INFANTRY REGIMENT ST BLDG 3306
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-4918
Mailing Address - Country:US
Mailing Address - Phone:706-544-9373
Mailing Address - Fax:
Practice Address - Street 1:5331 41ST INFANTRY REGIMENT ST BLDG 3306
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905-4918
Practice Address - Country:US
Practice Address - Phone:706-544-9373
Practice Address - Fax:762-408-8169
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCVAD 000Medicare UPIN