Provider Demographics
NPI:1144558669
Name:JENNINGS, DONNA FAYE (PA-C)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:FAYE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:FAYE
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9276 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4201
Mailing Address - Country:US
Mailing Address - Phone:571-516-3116
Mailing Address - Fax:571-516-3070
Practice Address - Street 1:9276 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4201
Practice Address - Country:US
Practice Address - Phone:571-516-3116
Practice Address - Fax:571-516-3070
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1471363AM0700X
VA0110009697363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01942 GROUPOtherBLUE SHIELD OF NEBRASKA