Provider Demographics
NPI:1497997126
Name:SUMMERS, JENNIFER (PA-C, RD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S WOODS MILL RD STE 58W
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3664
Mailing Address - Country:US
Mailing Address - Phone:314-878-2888
Mailing Address - Fax:314-576-8187
Practice Address - Street 1:226 S WOODS MILL RD STE 58W
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3664
Practice Address - Country:US
Practice Address - Phone:314-878-2888
Practice Address - Fax:314-576-8187
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011491363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical