Provider Demographics
NPI:1336192004
Name:CUNNING, JACQUELINE J (PA C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:CUNNING
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 1:310 FARM LN
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4732
Mailing Address - Country:US
Mailing Address - Phone:215-348-3990
Mailing Address - Fax:215-348-7705
Practice Address - Street 1:310 FARM LANE
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18904-4732
Practice Address - Country:US
Practice Address - Phone:215-348-3990
Practice Address - Fax:215-348-7705
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050801364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001435061OtherPERSCHOICE PERSCHOICE 65
21198960001OtherKEYSTONE HEALTH PLAN EAST
21198960001OtherKEYSTON HLT PLAN EAST 65
4708888939OtherFIRST HEALTH CCN
PC0140OtherHEALTH NET
0001435061OtherPENNSULVANIA BLUE SHIELD
598899143OtherMULTI PLAN
P543147OtherOXFORD
2119896001OtherAMERIHEALTH ADMINISTRATOR
470888939OtherINTERCOUNTY
CK4397OtherMEDICARE RAILROAD
007302OtherAETNA HMO
007302OtherAETNA PPO MANAGED CARE
PAP00044991OtherRAILROAD MEDICARE
1058232OtherKEYSTONE MERCY HEALTH PLA
2119896001OtherAMERIHEALTH HMO
278862OtherMAMSI
4708888939OtherDEVON
598899143OtherMULTI PLAN
PA071587Medicare ID - Type Unspecified