Provider Demographics
NPI:1689232381
Name:ANDERSON, JENNA KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:KAY
Other - Last Name:SNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:252 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1725
Mailing Address - Country:US
Mailing Address - Phone:620-653-2386
Mailing Address - Fax:620-653-4186
Practice Address - Street 1:906 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4720
Practice Address - Country:US
Practice Address - Phone:620-793-6990
Practice Address - Fax:620-793-3040
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant