Provider Demographics
NPI:1700808920
Name:RANKIE, JENNIFER (RPAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RANKIE
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:295 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5795
Practice Address - Country:US
Practice Address - Phone:166-301-1007
Practice Address - Fax:716-250-5901
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008786363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050301000150OtherFIDELIS CARE OF NEW YORK
NY02431189Medicaid
NY00027431501OtherUNIVERA
NY9511870OtherINDEPENDENT HEALTH
NY000570393002OtherBC/BS OF WNY
NY02431189Medicaid