Provider Demographics
NPI:1891724282
Name:LUNCEFORD, JENNIFER A (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LUNCEFORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MCGLAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:108 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3244
Mailing Address - Country:US
Mailing Address - Phone:903-386-3386
Mailing Address - Fax:
Practice Address - Street 1:1730 B F TERRY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5535
Practice Address - Country:US
Practice Address - Phone:866-989-2873
Practice Address - Fax:713-568-3313
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8192NPOtherBCBS
TXP01492565OtherRAIL ROAD
TX7057548OtherAETNA
TX75-1976930-005OtherTRICARE
TX187881104Medicaid
TX8821NFOtherBCBS
TX7057548OtherAETNA
TX187881104Medicaid
TX399548YS6VMedicare PIN