Provider Demographics
NPI:1649200072
Name:ATKINS, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ATKINS
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 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:US 23 AT INDIANOLA AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175
Practice Address - Country:US
Practice Address - Phone:606-932-3159
Practice Address - Fax:606-932-6896
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000598744OtherANTHEM BCBS
KY000000609840OtherANTHEM BCBS
KY000000623838OtherANTHEM BCBS
KY000000223253OtherANTHEM BCBS
KY95003448Medicaid
KY0631706Medicare PIN
KY000000623838OtherANTHEM BCBS
KY000000609840OtherANTHEM BCBS
KY95003448Medicaid
KY000000223253OtherANTHEM BCBS