Provider Demographics
NPI:1841586492
Name:WARD, JENNA IRENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:IRENE
Last Name:WARD
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:78 QUEENS ALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCK CAVE
Mailing Address - State:WV
Mailing Address - Zip Code:26234-5890
Mailing Address - Country:US
Mailing Address - Phone:304-924-6262
Mailing Address - Fax:304-924-6699
Practice Address - Street 1:78 QUEENS ALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCK CAVE
Practice Address - State:WV
Practice Address - Zip Code:26234-5890
Practice Address - Country:US
Practice Address - Phone:304-924-6262
Practice Address - Fax:304-924-6699
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV01488363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841586492Medicaid
WVWV1796BMedicare PIN