Provider Demographics
NPI:1194116350
Name:TENNEY, JANESSA (PA-C)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:TENNEY
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 W GROVE ST APT 608
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6270
Mailing Address - Country:US
Mailing Address - Phone:530-635-0505
Mailing Address - Fax:
Practice Address - Street 1:2939 W EXCURSION LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5308
Practice Address - Country:US
Practice Address - Phone:208-385-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant