| Doctor Name: | JACKI RENEE DEPANFILIS |
| NPI Number: | 1245583665 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA055834 |
| Business Practice Address: | 104 Metoxet St Suite A Ridgway, PA - 158531932 |
| Business Phone Number: | 8147728122 |
| Business Fax Number: | 8147727278 |
| Mailing Address: | 104 Metoxet St, Suite A RIDGWAY |
| State: | PA |
| Postal Code: | 158531932 |
| Phone Number: | 8147728122 |
| Fax Number: | 8147727278 |
| NPI Enumeration Date: | 10/23/2012 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA055834 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |