Individual
KEVIN JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
420 S JACKSON ST, POTTSVILLE, PA 17901-3625
(570) 621-5000
(570) 621-5589
Mailing address
420 S JACKSON ST, POTTSVILLE, PA 17901-3625
(570) 621-5000
(570) 621-5589
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA001406L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA001406L
PA LICENSE NUMBER
PA
Enumeration date
04/19/2011
Last updated
04/19/2011
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