MS. GWENETH FERDINAND-JACOB (NPI# 1922074459) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922074459 |
| Entity Type | Individual |
| Full Name | MS. GWENETH FERDINAND-JACOB |
| Credential | PA-C |
| Practice Address |
763 Mcclain Dr Clarksville TN 37040 |
| Mailing Address |
763 Mcclain Dr Clarksville TN 37040-5695 |
| Practice Telephone | 9319061823 |
| Practice Fax Number | 7313527644 |
| Mailing Telephone | 9319061823 |
| Mailing Fax Number | 7313527644 |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2012-04-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA969 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
763 MCCLAIN DR |
| City | CLARKSVILLE |
| State | TN |
| Zip Code | 37040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770124380 | Clarksville Treatment Center, LLC | Clinic/Center | 495 Dunlop Lane, Clarksville, TN 37040 | 2019-10-04 |
| 1295384956 | Dena Marie Borchick | Technician | 3779 Cindy Jo Dr. N, Clarksville, TN 37040 | 2019-09-05 |
| 1477014488 | Emily Allen | Dentist | 930 Hwy 76, Clarksville, TN 37040 | 2019-03-31 |
| 1730640566 | Latoya Ewert | Counselor | Centerstone Clarksville Harriet Cohn Center, 511 8th Street, Clarksville, TN 37040 | 2019-03-26 |
| 1356811988 | Jamie Coles | Behavior Technician | 851 Professional Park Drive 851 Profesiional Park Drive, Clarksville, TN 37040 | 2018-11-27 |
| 1518448554 | Bandel Counseling Service | Clinic/Center | 113 3rd St., Suite 25, Clarksville, TN 37040 | 2018-08-28 |
| 1477052520 | Bridget Stokes | Behavior Technician | 2277 Wilma Rudolph Blvd., Suite C #259, Clarksville, TN 37040 | 2018-02-05 |
| 1053824334 | Sandra Loren Coates | Nurse Practitioner | 980 Professional Park Dr Ste C, Clarksville, TN 37040 | 2017-11-09 |
| 1902328362 | Terri Brooke Roach | Registered Nurse | 651 Dunlop Lane, Clarksville, TN 37040 | 2017-07-07 |
| 1093244428 | Nikkia Deneil Bell | Behavior Technician | 139 E. Old Trenton Rd, Suite B, Clarksville, TN 37040 | 2017-06-08 |
| Find all providers in zip 37040 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033693320 | Marla Michelle Davis | Physician Assistant | 12272 Clarksville Pike Ste A, Clarksville, MD 21029-1229 | 2018-09-21 |
| 1326077041 | Red River Emergency Medicine Associates Pa | Physician Assistant | 3000 Hwy 82 W, Clarksville, TX 75426 | 2006-07-03 |
| 1295379568 | Zachary Pollock | Physician Assistant | 2690 Madison St Ste 130, Clarksville, TN 37043-6185 | 2019-10-30 |
| 1902465669 | Stephanie Lee Byard | Physician Assistant | 1000 Highway 76, Clarksville, TN 37043-8405 | 2019-06-06 |
| 1780155267 | Lindsey Davenport | Physician Assistant | 251 Hillcrest Dr, Clarksville, TN 37043-5086 | 2018-12-10 |
| 1730698671 | Mackenzie Zak Rickert | Physician Assistant | 651 Dunlop Ln, Clarksville, TN 37040-5015 | 2017-09-22 |
| 1588895635 | Anita Kline Taylor | Physician Assistant | 1000 Highway 76, Clarksville, TN 37043-8405 | 2009-08-06 |
| 1376789859 | Kimberly Sue Weiss | Physician Assistant | 6355 Ten Oaks Rd, Suite 202, Clarksville, MD 21029-1185 | 2009-01-05 |
| 1831373810 | Kristen R Dortch-farmer | Physician Assistant | 198 Old Farmers Rd, Clarksville, TN 37043-4032 | 2007-12-26 |
| 1548346166 | Jacqueline R Marco | Physician Assistant | 2320 Wilma Rudolph Blvd, Clarksville, TN 37040-5821 | 2006-10-27 |
| Find all providers in CLARKSVILLE | ||||
| City | CLARKSVILLE |
| Zip Code | 37040 |
Please comment or provide details below to improve the information on MS. GWENETH FERDINAND-JACOB.
| 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.