JENNIFER L PACK (NPI# 1396786562) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396786562 |
| Entity Type | Individual |
| Full Name | JENNIFER L PACK |
| Credential | PA-C |
| Practice Address |
122 12th St Princeton WV 24740 |
| Mailing Address |
Po Box 634715 Cincinnati OH 45263-0001 |
| Practice Telephone | 3044877000 |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2007-11-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 878 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | MEDICARE RAILROAD | P00343573 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902342330 | Jennifer Pack | Marriage & Family Therapist | 100 Masonic Ave, San Francisco, CA 94118-4415 | 2017-01-09 |
| 1457552317 | Jennifer Lynn Pack | Nurse Practitioner | 3003 N Central Ave, Suite 800, Phoenix, AZ 85012-2902 | 2007-05-29 |
| Street Address |
122 12TH ST |
| City | PRINCETON |
| State | WV |
| Zip Code | 24740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326049586 | Thomas Charles Martin Jr. | Pathology | 122 12th St, Princeton, WV 24740-2312 | 2005-08-09 |
| 1508495169 | Valerie Renee Mould | Pharmacist | 122 12th St, Princeton, WV 24740-2312 | 2020-04-06 |
| 1295360501 | Kaitlin Douglas | Nurse Practitioner | 122 12th St, Princeton, WV 24740-2312 | 2020-03-06 |
| 1851843114 | Phillip Sean Mckenzie | Nurse Practitioner | 122 12th St, Princeton, WV 24740-2312 | 2016-11-02 |
| 1508310814 | Corey White | Internal Medicine | 122 12th St, Princeton, WV 24740-2312 | 2016-08-04 |
| 1548610975 | Cassidy Smith | Internal Medicine | 122 12th St, Princeton, WV 24740-2312 | 2016-06-16 |
| 1649666488 | Ryan Craddock | Internal Medicine | 122 12th St, Princeton, WV 24740 | 2015-04-08 |
| 1912307323 | Megan Alyse Meadows | Nurse Practitioner | 122 12th St, Princeton, WV 24740-2312 | 2014-09-04 |
| 1497193007 | Shawn L. Vest | Nurse Practitioner | 122 12th St, Princeton, WV 24740-2312 | 2013-06-06 |
| 1780997098 | Arthi Vasudevan Price | Physician Assistant | 122 12th St, Princeton, WV 24740-2312 | 2010-07-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658632 | New Beginnings Therapy Services, LLC | Community/Behavioral Health | 616 Harrison Street, Princeton, WV 24740 | 2020-10-27 |
| 1215536222 | Right At Home | Home Health | 313 Locus St, Princeton, WV 24740 | 2020-10-21 |
| 1881208098 | Robin Lane | Technician | 174 Tea Kettle Road, Princeton, WV 24740 | 2020-09-04 |
| 1134739824 | Nona Arthur | Technician | 708 Bluefiled Ave, Princeton, WV 24740 | 2020-08-06 |
| 1851909014 | Tina B Altizer | Speech-Language Pathologist | 120 12th Street, Princeton, WV 24740 | 2020-07-14 |
| 1245712504 | Tracy Jean Mitchell | Speech-Language Pathologist | 1200 Mercer St, Princeton, WV 24740 | 2018-09-04 |
| 1700305240 | Tina Six | Registered Nurse | 1403 Honaker Avenue, Princeton, WV 24740 | 2017-09-15 |
| 1013449172 | Karin Cappa | Pharmacist | 669 Cornfield Rd, Princeton, WV 24740 | 2017-03-29 |
| 1942661723 | Virginia Chryssikos | Social Worker | 3016 E Cumberland Road, Bluestone Family Practice, Bluefield, WV 24740 | 2016-03-08 |
| 1477939460 | Kathy Diane Wyrick | Counselor | 220 South Walker Street, Princeton, WV 24740 | 2015-08-03 |
| Find all providers in zip 24740 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205464724 | Shraddha S Patel | Physician Assistant | 29 Goldstar Dr, Princeton, NJ 08540-8578 | 2020-03-30 |
| 1538702154 | Sahara Stanley | Physician Assistant | 104 Mahood Ave, Princeton, WV 24740-2617 | 2019-10-27 |
| 1205210853 | Homer K Lester | Physician Assistant | 112 12th St, Princeton, WV 24740-2312 | 2015-07-14 |
| 1285039420 | Deaconess Clinic, Inc. | Physician Assistant | 1414 W Broadway St, Princeton, IN 47670-1142 | 2014-10-30 |
| 1154738839 | Brittany Hope Jewell | Physician Assistant | 508 New Hope Rd Ste 102, Princeton, WV 24740-2265 | 2014-07-15 |
| 1861638561 | Adeyemi Babatunde Williams | Physician Assistant | 60 Hoover Ave, Princeton, NJ 08540-4639 | 2008-12-30 |
| 1184793556 | Joseph Harold Thornton | Physician Assistant | Princeton University Health, Mccosh Health Center, Princeton, NJ 08544-0001 | 2006-11-07 |
| 1104919828 | Leah D Petrunger | Physician Assistant | 150 Misty Lane, Princeton, WV 24740 | 2006-10-02 |
| 1437756350 | Olivia N Dudley | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-10-04 |
| 1952919417 | Madelyn L Schwartz | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2020-07-21 |
| Find all providers in PRINCETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.