Renee G Jury, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA001536L Issued in PA

Practice address

915 Benner Pike
State College, PA 16801-7395

Phone

(814) 867-7030

Fax

(814) 867-7032

NPI assigned

Apr 4, 2006

Last updated

Feb 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1609838903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 BENNER PIKE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017395",
            "telephone_number": "814-867-7030",
            "fax_number": "814-867-7032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 BENNER PIKE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017395",
            "telephone_number": "814-867-7030",
            "fax_number": "814-867-7032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JURY",
        "first_name": "RENEE",
        "middle_name": "G",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-04",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA001536L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in State College, PA
• Providers in State College, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.