ASHLEY L JACK (NPI# 1134493620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134493620 |
| Entity Type | Individual |
| Full Name | ASHLEY L JACK |
| Credential | PA-C |
| Practice Address |
655 Seventh Street, Bldg 700 Centerville GA 31028 |
| Mailing Address |
105 Valencia Cir Centerville GA 31028-1339 |
| Practice Telephone | 3039318976 |
| Mailing Telephone | 3039318976 |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2015-05-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
655 SEVENTH STREET, BLDG 700 |
| City | CENTERVILLE |
| State | GA |
| Zip Code | 31028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891278743 | Latonia Queen Howard | Nurse Practitioner | 804 Arbor Ln, Centerville, GA 31028 | 2018-09-06 |
| 1407815491 | Elizabeth Marie Soety | Clinical Neuropsychologist | 102 Gunn Rd, Centerville, GA 31028 | 2006-03-20 |
| 1013147743 | Neuropsychological Testing and Counseling | Clinical Neuropsychologist | 102 Gunn Rd, Centerville, GA 31028 | 2009-07-15 |
| 1982750766 | Denise Patrick Noel | Dentist | 618 N Houston Lake Blvd, Centerville, GA 31028-1010 | 2007-01-26 |
| 1093149874 | Janki Desai Patel | Dentist | 618 N Houston Lake Blvd, Centerville, GA 31028-1010 | 2013-08-28 |
| 1255640082 | Denise P Noel | Dentist | 618 N Houston Lake Blvd, Centerville, GA 31028-1010 | 2010-09-28 |
| 1518516228 | Emeli Eleyn Burlison | Dental Hygienist | 428 Sentry Oak Dr, Centerville, GA 31028-1200 | 2019-09-05 |
| 1083739346 | Antonia K Taylor | Optometrist | 2930 Watson Blvd, Centerville, GA 31028-1245 | 2007-03-19 |
| 1265506695 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 2930 Watson Blvd, Galleria Mall, Centerville, GA 31028-1245 | 2006-11-18 |
| 1447878020 | Shanta Lafaye Watkins | Adult Companion | 103 Ashlund Dr, Centerville, GA 31028-1262 | 2020-07-09 |
| Find all providers in zip 31028 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497368153 | Emily Christine Fedders | Physician Assistant | 512 Broadway St, Centerville, SD 57014-2225 | 2020-08-24 |
| 1235524323 | Allison M. Friberg | Physician Assistant | 1185b Falmouth Road, Centerville, MA 02632 | 2015-04-06 |
| 1356426639 | Shelly J Geloneck | Physician Assistant | 1235 E. Alex Bell Rd, Centerville, OH 45459 | 2006-10-26 |
| 1972549947 | Shirley Jeanne Baker | Physician Assistant | 607 Lassater, Centerville, TX 78533 | 2006-06-20 |
| 1336140896 | Donald E Bogard II | Physician Assistant | 2350 Miami Valley Dr Ste 500, Centerville, OH 45459-4780 | 2005-08-09 |
| 1376195628 | Lulu Hong | Physician Assistant | 7095 Clyo Rd, Centerville, OH 45459-4816 | 2019-07-16 |
| 1548828825 | Manuel Alvarez Jr. | Physician Assistant | 2350 Miami Valley Dr Ste 500, Centerville, OH 45459-4780 | 2019-06-03 |
| 1417444134 | Denise Ellene Buenger | Physician Assistant | 2400 Miami Valley Dr, Centerville, OH 45459-4774 | 2018-04-18 |
| 1023521085 | Kayla Michelle Fryman | Physician Assistant | 7677 Yankee St, Centerville, OH 45459-3475 | 2017-11-13 |
| 1487186854 | Martin Hummel | Physician Assistant | 1235 E Alex Bell Rd, Centerville, OH 45459-2658 | 2017-04-03 |
| Find all providers in CENTERVILLE | ||||
| City | CENTERVILLE |
| Zip Code | 31028 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.