Provider Demographics
NPI:1992204028
Name:LUCY, JENNIFER KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:LUCY
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 1:2550 MOSSIDE BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3533
Mailing Address - Country:US
Mailing Address - Phone:412-373-1600
Mailing Address - Fax:412-373-4197
Practice Address - Street 1:2550 MOSSIDE BLVD STE 405
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146
Practice Address - Country:US
Practice Address - Phone:412-373-1600
Practice Address - Fax:412-373-4197
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0045652255A2300X
PAMA059696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid
PA14329441OtherCAQH