| Doctor Name: | JESSICA LYNN FENNER |
| NPI Number: | 1003144882 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA054157 |
| Business Practice Address: | 175 E Brown St Suite 115 East Stroudsburg, PA - 183013098 |
| Business Phone Number: | 5704247764 |
| Business Fax Number: | 5704210760 |
| Mailing Address: | Po Box 564, BRODHEADSVILLE |
| State: | PA |
| Postal Code: | 183220564 |
| Phone Number: | 5709920955 |
| Fax Number: | |
| NPI Enumeration Date: | 12/07/2009 |
| NPI Last Update Date: | 12/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA054157 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |