Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jennifer A Prom, PAC

Individual provider Physician Assistant · NPI 1215948781

Jennifer A Prom, PAC is a Physician Assistant in Duluth, Minnesota. Qualified in 2005, 21 years ago. Practices with St Luke's Hospital of Duluth, a 413-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota and Wisconsin.

Years since qualifying
21
Licensed in
MN, WI
In the registry since
2006
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

619 W Central Entrance
Duluth, MN 55811-5448
Phone: (218) 249-4987
Fax: (218) 249-4989
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 109 N 28th St E, Superior, WI 54880-6548 — (715) 395-3950

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 10142 (MN)
Physician Assistant Taxonomy 363A00000X · Licence 4215 (WI)

Record details

NPI number1215948781
Entity typeIndividual (Type 1)
GenderFemale
Credentials PAC
Sole proprietorNo
NPI enumeratedAugust 10, 2006
Last updated in NPPESDecember 16, 2020
Certification dateDecember 16, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice St. Luke'S Hospital Of Duluth — 413 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in Duluth