MADDILYN LUELLA JACKSON (NPI# 1790314946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790314946 |
| Entity Type | Individual |
| Full Name | MADDILYN LUELLA JACKSON |
| Credential | PA-C |
| Practice Address |
9000 Brooktree Rd Ste 200 Wexford PA 15090-9288 |
| Practice Telephone | 7249331320 |
| Mailing Telephone | 7249331320 |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-10-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
MA061384 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
9000 BROOKTREE RD STE 200 |
| City | WEXFORD |
| State | PA |
| Zip Code | 15090-9288 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194142059 | Megan Sue Carrigan | Dermatology | 9000 Brooktree Rd Ste 200, Wexford, PA 15090-9288 | 2014-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932746443 | Lauren Jennifer Kinder | Nurse Practitioner | 103 North Meadows Dr., Suite 220, Wexford, PA 15090 | 2019-12-03 |
| 1235608365 | Pittsburgh Ear LLC | Audiologist | 6041 Wallace Road Ext, Suite 110, Wexford, PA 15090 | 2018-11-19 |
| 1659847739 | Anna Zenkova | Physician Assistant | 10466 Perry Highway, Baierl Honda Cpo Building. 2nd Floor., Wexford, PA 15090 | 2018-10-16 |
| 1831674571 | Comprehensive Care Multi-specialty Physician Organization PC | Internal Medicine | 6400 Brooktree Court., Suite. 320, Wexford, PA 15090 | 2018-09-28 |
| 1760989115 | Kerry L Vaughn | Nurse Practitioner | 12311 Perry Hwy Fl 1, Wexford, PA 15090 | 2018-04-11 |
| 1821446097 | John Richard Moesch | Internal Medicine | 9000 Brooktree Rd, Brooktree Office Park, Suite 2000, Hexford, PA 15090 | 2016-05-28 |
| 1336595511 | Kelly Mea | Occupational Therapist | 10475 Perry Hwy Ste 106g, Wexford, PA 15090 | 2016-05-06 |
| 1194194282 | Natassia Dickey | Counselor | 101 N Meadows Dr Ste 234, Wexford, PA 15090 | 2015-09-18 |
| 1912382631 | Jessica Hamilton | Dietitian, Registered | 155 Towne Centre Avenue, Wexford, PA 15090 | 2015-07-23 |
| 1205211224 | Tamara Domnitz | Optometrist | 110 Vip Dr Ste 301, Wexford, PA 15090 | 2015-07-21 |
| Find all providers in zip 15090 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710525258 | Caroline Anne O'neil | Physician Assistant | 10431 Perry Hwy Ste 300, Wexford, PA 15090-9200 | 2019-12-16 |
| 1659847739 | Anna Zenkova | Physician Assistant | 10466 Perry Highway, Baierl Honda Cpo Building. 2nd Floor., Wexford, PA 15090 | 2018-10-16 |
| 1285932228 | Kristin A Smith | Physician Assistant | 900 Brooktree Rd, Suite 200, Wexford, PA 15090-9255 | 2011-02-28 |
| 1811203300 | Kari Michelle Jones | Physician Assistant | 1500 Village Run Rd Ste 300, Wexford, PA 15090 | 2010-08-23 |
| 1467786129 | Rebecca A. Torquato | Physician Assistant | 103 Bradford Road, Suite 220 Stonewood Commons II, Wexford, PA 15090 | 2009-09-29 |
| 1558436774 | Tiffany D. Pellathy | Physician Assistant | 3000 Village Run Rd, Bldg. 103-202, Wexford, PA 15090-6315 | 2006-11-22 |
| 1295731693 | Nicole M Bowan | Physician Assistant | 5500 Brooktree Rd, Ste 201, Wexford, PA 15090-9260 | 2005-06-22 |
| 1841839339 | Kristen Jackson | Physician Assistant | 6001 Stonewood Dr, Wexford, PA 15090-7380 | 2019-12-31 |
| 1003457490 | Victoria Ryan | Physician Assistant | 7000 Stonewood Dr Ste 151, Wexford, PA 15090-7376 | 2019-10-07 |
| 1972021210 | Rebecca D Heim | Physician Assistant | 7000 Stonewood Dr Ste 151, Wexford, PA 15090-7376 | 2017-09-07 |
| Find all providers in WEXFORD | ||||
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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.