JENNIFER DESIREE DOUGLAS (NPI# 1023044906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023044906 |
| Entity Type | Individual |
| Full Name | JENNIFER DESIREE DOUGLAS |
| Credential | PA |
| Practice Address |
171 Ashley Ave Charleston SC 29425-8908 |
| Mailing Address |
Po Box 751461 Charlotte NC 28275-1461 |
| Practice Telephone | 8437921414 |
| Mailing Telephone | 8437926200 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-04-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 3509 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | MA051653 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 0110001232 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689157570 | Jennifer Joy Douglas | Home Health | 935 Pyramid Hill Blvd Apt 3b, Hamilton, OH 45013-6420 | 2018-09-07 |
| 1235476706 | Jennifer Douglas | Registered Nurse | 1520 Kelly Pl Ste 220, Walla Walla, WA 99362-8607 | 2013-01-03 |
| 1992050470 | Jennifer Lynn Douglas | Social Worker | 2501 Hunter Pl Ste 201, Woodbridge, VA 22192-3940 | 2012-07-19 |
| 1710032388 | Jennifer Douglas | Speech-Language Pathologist | 7009 Stonehenge Rd, Odessa, TX 79765 | 2007-01-24 |
| 1861479792 | Jennifer A Douglas | Family Medicine | 6521 Route 22, Delmont, PA 15626-2402 | 2005-12-30 |
| 1659904522 | Jennifer R Douglas | Counselor | 537 W 18th St, Erie, PA 16502-1722 | 2020-02-19 |
| 1114559036 | Jennifer G Douglas | Nurse Practitioner | 6730 Roosevelt Ave Ste 201, Middletown, OH 45005-5730 | 2020-02-08 |
| 1063996452 | Jennifer L Douglas | Behavior Technician | 90 Hawes Way, Stoughton, MA 02072-1163 | 2018-09-20 |
| 1790264976 | Jennifer L Douglas | Case Manager/Care Coordinator | 19 Robinson Rd, Clinton, NY 13323-1418 | 2018-08-09 |
| 1437668894 | Jennifer Douglas | Behavior Technician | 9150 Bereford Dr, Baton Rouge, LA 70809-2403 | 2017-09-28 |
| Street Address |
171 ASHLEY AVE |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29425-8908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942203922 | Nicholas J Pastis Jr. | Internal Medicine | 171 Ashley Ave, Charleston, SC 29425-8900 | 2005-05-24 |
| 1760083745 | Eleta Lazar Donelan | Physician Assistant | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-11-05 |
| 1285231340 | Bree Romecki | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-10-02 |
| 1942812078 | Warren Allen James | Student in an Organized Health Care Education/Training Program | 171 Ashley Ave, Charleston, SC 29425-8908 | 2020-08-19 |
| 1457962060 | Rosmary Ros-demarize | Psychologist | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-08-17 |
| 1558971390 | Auryelle Ascue | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-8908 | 2020-08-06 |
| 1396361994 | David Gonzalez | Nurse Practitioner | 171 Ashley Ave, Charleston, SC 29425-8911 | 2020-06-19 |
| 1003432592 | Hannah Burrick | Audiologist | 171 Ashley Ave, Charleston, SC 29425-8903 | 2020-06-19 |
| 1528683562 | Kelsey Renee Full | Emergency Medicine | 171 Ashley Ave, Charleston, SC 29425-0100 | 2020-06-16 |
| 1861017949 | Christina Lee | Anesthesiology | 171 Ashley Ave, Charleston, SC 29425-8908 | 2020-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922607217 | Krishna Bhandari | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10 Mcclennan Banks Drive, 2190-r, Msc 918, Charleston, SC 29425 | 2020-10-19 |
| 1649892456 | Mary Macrae Lynch | Social Worker | 179 Ashley Avenue, Charleston, SC 29425 | 2020-05-14 |
| 1528600053 | Amanda Watts | Physician Assistant | 135 Rutledge Ave. Msc 561, Charleston, SC 29425 | 2019-10-16 |
| 1851945497 | Kacy Wonder | Dentist | 173 Ashley Avenue Room 453 Msc 507, Charleston, SC 29425 | 2019-08-01 |
| 1477114569 | Justin Robert Silverman | Surgery | 169 Ashley Avenue, Room 202 Muh, Msc 333, Charleston, SC 29425 | 2019-06-28 |
| 1740840024 | Tyler Buckley | Surgery | 169 Ashley Ave, Room 202 Main Hospital, Msc333, Charleston, SC 29425 | 2019-06-18 |
| 1366001760 | Rayphael Sebastian Hardy | Internal Medicine | 169 Ashley Avenue Room 202 Main Hospital Msc333, Charleston, SC 29425 | 2019-06-10 |
| 1437718889 | Samar Medani | Internal Medicine | Division of Nephrology, Medical Univ of South Carolina, 96 Jonathan Lucas Street, Room 822, Msc 629, Charleston, SC 29425 | 2019-06-10 |
| 1427617950 | Emily Suzanne Nyers | Internal Medicine | 169 Ashley Ave., Room 202 Main Hospital, Msc 333, Charleston, SC 29425 | 2019-06-09 |
| 1790343564 | Alan Cowei Peh | Psychiatry & Neurology | 169 Ashley Avenue Rm 202, Main Hospital Msc 333, Charleston, SC 29425 | 2019-06-05 |
| Find all providers in zip 29425 | ||||
| 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 |
|---|---|---|---|---|
| 1609475326 | Rebecca Whealen | Physician Assistant | 2026 Huber Rd, Charleston, WV 25314-2236 | 2020-10-23 |
| 1275131054 | Ethan Brody Clontz | Physician Assistant | 1953 Pinehurst Ave, Charleston, SC 29414-6483 | 2020-10-13 |
| 1386251635 | Caitlin Estep | Physician Assistant | 3100 Maccorkle Ave Se Ste 802, Charleston, WV 25304-1233 | 2020-09-29 |
| 1487261509 | Reilly Kilpatrick | Physician Assistant | 1518 Blaze Ln, Charleston, SC 29412-8652 | 2020-09-24 |
| 1083228514 | Andrea Denise Boan | Physician Assistant | 12 Commercial Row Apt A, Charleston, SC 29412-3641 | 2020-09-02 |
| 1194343673 | Andrew N Brewer | Physician Assistant | 171 Ashley Ave Ste 419, Charleston, SC 29425-8908 | 2020-07-10 |
| 1396361309 | Jacquelyn Joseph | Physician Assistant | 134 Howard Mary Dr Apt A, Charleston, SC 29412-9581 | 2020-06-25 |
| 1639719990 | Jessy Marie Hamrick | Physician Assistant | 149 Dutch Rd Apt 105, Charleston, WV 25302-2530 | 2020-01-14 |
| 1093355521 | Virginia Noemi Escobar-cheng | Physician Assistant | 310 Red Mulberry Way Apt 3, Charleston, WV 25306-6395 | 2020-01-13 |
| 1598300279 | Breanne Marie Wiekamp | Physician Assistant | 20 Scarlet Oak Ln Apt 3, Charleston, WV 25306-1128 | 2019-11-17 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29425 |
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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.