Basic Information
| Provider Information | |||||||||
| NPI: | 1598137523 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | DEVON | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 COAL VALLEY RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | CLAIRTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122676600 | ||||||||
| FaxNumber: | 4122676281 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 COAL VALLEY RD STE 209 | ||||||||
| Address2: | |||||||||
| City: | CLAIRTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122676600 | ||||||||
| FaxNumber: | 4122676281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2015 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | MW010414 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 103180961 | 05 | PA | MEDICAID |