Provider Demographics
NPI:1457354789
Name:CHAVEZ, JENNIFER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CHAVEZ
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 1:9850 NICHOLAS ST
Mailing Address - Street 2:STE 250
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2186
Mailing Address - Country:US
Mailing Address - Phone:402-399-9990
Mailing Address - Fax:402-393-1042
Practice Address - Street 1:9850 NICHOLAS ST
Practice Address - Street 2:STE 250
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2186
Practice Address - Country:US
Practice Address - Phone:402-399-9990
Practice Address - Fax:402-393-1042
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1136363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE68154A016OtherTRICARE
NE47073679913Medicaid
NE47081304012Medicaid
NEP00153597OtherRAILROAD MEDICARE
NE37833OtherBCBS
NEP00153597OtherRAILROAD MEDICARE
NE37833OtherBCBS