Provider Demographics
NPI:1942247309
Name:MCKOWN, JENAFER ELAINE (PA)
Entity Type:Individual
Prefix:
First Name:JENAFER
Middle Name:ELAINE
Last Name:MCKOWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENAFER
Other - Middle Name:ELAINE
Other - Last Name:BROCKLEHURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2W CRESCENT PARK
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2111
Mailing Address - Country:US
Mailing Address - Phone:814-723-4973
Mailing Address - Fax:814-723-2248
Practice Address - Street 1:2 W CRESCENT PARK FL 3
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-723-0273
Practice Address - Fax:814-726-9416
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002344L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014080Medicare PIN
PAS60993Medicare UPIN