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Individual
JACKLYNN A KMENT
Active
Individual
JACKLYNN A KMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
598
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37758
BLUE SHIELD
NE
05
—
47065843713
—
NE
01
—
970013133
RAILROAD MEDICARE
NE
Enumeration date
07/07/2005
Last updated
02/19/2019
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