Provider Demographics
NPI:1851302830
Name:FEHRINGER, JENNIFER L (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FEHRINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 OSBORNE DR W
Mailing Address - Street 2:100
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-9112
Mailing Address - Country:US
Mailing Address - Phone:402-462-2139
Mailing Address - Fax:402-462-2381
Practice Address - Street 1:2207 OSBORNE DR W
Practice Address - Street 2:100
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9112
Practice Address - Country:US
Practice Address - Phone:402-462-2139
Practice Address - Fax:402-462-2381
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1196363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063010113Medicaid
NE38722OtherBCBS NEBRASKA
NEP00246376OtherP00246376 RR MEDICARE
NEP51185Medicare UPIN
NE279279Medicare ID - Type Unspecified