# MS. JENNIFER C CLEMENTE-METZ

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1962562801
- **Gender:** F
- **Credential:** PA-C, M.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | 10000891A | IN | — |
| 363A00000X | Physician Assistant | 10000891AB | IN | Yes |
| 363A00000X | Physician Assistant | PA745 | KY | — |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 11/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 10000891A | STATE LICENSE | IN |
| 05 | — | 300006743 | — | IN |
| 01 | — | IN3604007 | MEDICARE INDIANA | IN |
| 01 | — | PA745 | STATE LICENSE | KY |