Provider Demographics
NPI:1336599067
Name:PRICE, JENNIFER BRIANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BRIANNE
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:BRIANNE
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4130 PIONEER WOODS DRIVE
Mailing Address - Street 2:STE #1
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-617-9103
Mailing Address - Fax:
Practice Address - Street 1:4130 PIONEER WOODS DRIVE
Practice Address - Street 2:STE #1
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-617-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant