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Individual
JENNA L KAVANAUGH
Active
Individual
JENNA L KAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05983
TX
363AS0400X
Surgical Physician Assistant
PA05983
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200565402
—
TX
05
—
200565403
—
TX
Enumeration date
12/03/2008
Last updated
06/14/2017
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