# JASON R HENNESSEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1164530317
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 989 | NE | Yes |

## Other

- **Enumeration date:** 08/28/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1052768 | NCCPA | NE |
| 01 | — | 37394 | BCBSNE | NE |
| 01 | — | 989 | PA LICENSE | NE |