Provider Demographics
NPI:1538359690
Name:MCCORMICK, JENNY KRISTIN (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:KRISTIN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:KRISTIN
Other - Last Name:BOTTOMLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSSB BUILDING, 4150 V STREET, #2100
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE UC DAVIS SOM
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:617-852-3761
Mailing Address - Fax:
Practice Address - Street 1:PSSB BUILDING, 4150 V STREET, #2100
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE UC DAVIS SOM
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218597207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine