Provider Demographics
NPI:1215019427
Name:SOMMERS, JENNIFER CHAMPAGNE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHAMPAGNE
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:CHAMPAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8865 SYNERGY DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6521
Mailing Address - Country:US
Mailing Address - Phone:972-562-1119
Mailing Address - Fax:972-529-9510
Practice Address - Street 1:8865 SYNERGY DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6521
Practice Address - Country:US
Practice Address - Phone:972-562-1119
Practice Address - Fax:972-529-9510
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA047939363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ77242Medicare UPIN
TX8J3027Medicare PIN
TX00212XMedicare PIN