Provider Demographics
NPI:1255540357
Name:JENNE, ASHLEY ANNE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANNE
Last Name:JENNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:ANNE
Other - Last Name:WOODBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:410 E MANDALAY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1744
Mailing Address - Country:US
Mailing Address - Phone:210-824-1266
Mailing Address - Fax:
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:SUITE 325
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-615-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant