DR. JACQUELINE CAROL WILK (NPI# 1528251840) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528251840 |
| Entity Type | Individual |
| Full Name | DR. JACQUELINE CAROL WILK |
| Credential | MD |
| Practice Address |
2825 E Barnett Rd Medford OR 97504-8332 |
| Mailing Address |
1208 Beall Ln Central Point OR 97502-1573 |
| Practice Telephone | 5417894700 |
| Mailing Telephone | 5416645151 |
| Mailing Fax Number | 5416645155 |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2009-06-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
MD29023 | OR | Allopathic & Osteopathic Physicians |
| N | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
MD29023 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICAL LICENSE | MD29023 | 01 |
| Street Address |
2825 E BARNETT RD |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-8332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770587107 | Asante | General Acute Care Hospital | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2005-06-13 |
| 1497352975 | Angela Kim | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2020-10-07 |
| 1093330235 | James Allen Garcia | Registered Nurse | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2020-06-13 |
| 1386283166 | Ruthie Nguyen | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-12-27 |
| 1235772401 | Michael Lanning | Pharmacy | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-10-21 |
| 1487295994 | Nicole Mehl | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-10-06 |
| 1073154191 | Therese Marguerite Wavrin | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-09-30 |
| 1063063311 | Kirsten Laity | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-09-26 |
| 1790336568 | Shane Vanhandel | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-09-24 |
| 1861043663 | Rebecca Ann Kimmel | Pharmacist | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2019-09-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003879487 | Milagros Calderon Malicdem | Pediatrics | 3 Penny Ln, Medford, NJ 08055-3477 | 2006-04-07 |
| 1366687998 | Katie Lynn Townes Mcmann | Pediatrics | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2008-12-11 |
| 1306896436 | Newborn Critical Care Associates, PC | Pediatrics | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2006-05-11 |
| 1699767566 | Patricia L Jett | Pediatrics | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2005-08-17 |
| 1275525248 | Pushkar S Wadgaonkar | Pediatrics | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2005-08-16 |
| 1093707069 | Lee C Harker | Pediatrics | 2825 E Barnett Rd, Medford, OR 97504-8332 | 2005-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831212976 | Douglas Terry Leonard | Pediatrics | 3355 River Bend Dr., Suite 220, Springfield, OR 97477-8800 | 2007-04-06 |
| 1033273453 | John Edward Yount | Pediatrics | 3206 Caribou Ct Nw, Salem, OR 97304-2305 | 2006-12-20 |
| 1992878169 | Michael Adrian Colasurdo | Pediatrics | 3355 Riverbend Dr Ste 220, Springfield, OR 97477-8800 | 2006-11-16 |
| 1073611687 | Breton Charles Freitag | Pediatrics | 501 N Graham Street, Suite 265, Portland, OR 97227 | 2006-09-20 |
| 1457319295 | Sean L Sweeney | Pediatrics | 501 N Graham St Ste 265, Portland, OR 97227-2000 | 2006-05-02 |
| 1124006598 | Thurman Allen Merritt | Pediatrics | 701 N 5th St Unit C1020, Lebanon, OR 97355-9599 | 2006-01-05 |
| 1932641180 | Holly Kay Hunt | Pediatrics | 9205 Sw Barnes Rd, Portland, OR 97225-6603 | 2016-11-04 |
| 1164765590 | Casey Sterling Ward | Pediatrics | 501 N Graham St Ste 265, Portland, OR 97227-2000 | 2013-04-04 |
| 1003159757 | Megan Furnari | Pediatrics | 3181 Sw Sam Jackson Park Road, Portland, OR 97239 | 2013-04-01 |
| 1811254188 | Leah Yieh | Pediatrics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2012-04-11 |
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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.