Provider Demographics
NPI:1265985626
Name:CUSHMAN, JENNIFER DONNELLY (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DONNELLY
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7201 76TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-0722
Mailing Address - Country:US
Mailing Address - Phone:806-239-3017
Mailing Address - Fax:
Practice Address - Street 1:7201 76TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-0722
Practice Address - Country:US
Practice Address - Phone:806-239-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2017-0003207R00000X, 363AM0700X
WAPA61021112363A00000X, 363AM0700X
TXPA11037363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant