Provider Demographics
NPI:1932753183
Name:AMMONS, JENNA WHITTINGTON (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:WHITTINGTON
Last Name:AMMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:WHITTINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2921
Mailing Address - Country:US
Mailing Address - Phone:919-820-0070
Mailing Address - Fax:
Practice Address - Street 1:800 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5510
Practice Address - Country:US
Practice Address - Phone:910-892-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant