Provider Demographics
NPI:1699148254
Name:MENG, JENNA JOHNSON (PA-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:JOHNSON
Last Name:MENG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARISSA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1585 GEARY ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-1303
Mailing Address - Country:US
Mailing Address - Phone:352-538-5602
Mailing Address - Fax:
Practice Address - Street 1:2104 N VILLAGE DR STE L
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4312
Practice Address - Country:US
Practice Address - Phone:530-582-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113166363AM0700X
NVPA2873363AM0700X
CAPA53083363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical