Provider Demographics
NPI:1053751479
Name:BROWN, JENNIFER WHITNEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WHITNEY
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:WHITNEY
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4420 DUCKHORN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2590
Mailing Address - Country:US
Mailing Address - Phone:916-419-9900
Mailing Address - Fax:916-419-9699
Practice Address - Street 1:4420 DUCKHORN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2590
Practice Address - Country:US
Practice Address - Phone:916-419-9900
Practice Address - Fax:916-419-9699
Is Sole Proprietor?:No
Enumeration Date:2013-06-29
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant