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Individual

KATIE ROSE JENNINGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3000 OLD CENTRE RD, PORTAGE, MI 49024-4883
(269) 321-7546
(269) 321-1705
Mailing address
215 CALICO AVE, PORTAGE, MI 49002-7078

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011951
MI
363AM0700X
Medical Physician Assistant
5601011951
MI

Other

Enumeration date
09/06/2023
Last updated
04/20/2026
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