Individual
MS. JENNA RENEE DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
460 WILSON AVE, FIRST FLOOR, VERSAILLES, KY 40383-1947
(859) 879-0111
(859) 879-0363
Mailing address
460 WILSON AVE, FIRST FLOOR, VERSAILLES, KY 40383-1947
(859) 879-0111
(859) 879-0363
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1584
KY
363AM0700X
Medical Physician Assistant
PA1584
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100170500
—
KY
Enumeration date
12/02/2010
Last updated
06/09/2022
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