Provider Demographics
NPI:1720081565
Name:HARRINGTON, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:HARRINGTON
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 1:841 S HIGHWAY 25 W # S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-4600
Mailing Address - Country:US
Mailing Address - Phone:606-549-8521
Mailing Address - Fax:
Practice Address - Street 1:841 S HIGHWAY 25 W # S
Practice Address - Street 2:SUITE 5
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-4600
Practice Address - Country:US
Practice Address - Phone:606-549-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA628363AM0700X
TNPA806363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3669921Medicaid
KY64913864Medicaid
TN3669921Medicaid
TN3669922Medicare ID - Type Unspecified
KY64913864Medicaid