Individual
MRS. JENNIFER L MCCARTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
34 HYBROOK RD SOUTH, DIVIDE, CO 80814
(719) 632-5700
(719) 344-7817
Mailing address
3205 N ACADEMY BLVD, SUITE 130, COLORADO SPRINGS, CO 80917-5101
(719) 632-5700
(719) 344-7837
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2997
CO
363A00000X
Physician Assistant
PA9103485
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46681230
—
CO
01
—
57561Z
MEDICARE
FL
01
—
COA101228
MEDICARE NUMBER
CO
Enumeration date
11/29/2006
Last updated
04/04/2017
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