JACLYN L MIS (NPI# 1073899548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073899548 |
| Entity Type | Individual |
| Full Name | JACLYN L MIS |
| Other Name | JACLYN L CROWE |
| Credential | PAC |
| Practice Address |
2320 High St Blue Island IL 60406-2426 |
| Practice Telephone | 7083885500 |
| Practice Fax Number | 7083885672 |
| Mailing Telephone | 7083885500 |
| Mailing Fax Number | 7083885672 |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085004190 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2320 HIGH ST |
| City | BLUE ISLAND |
| State | IL |
| Zip Code | 60406-2426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205823093 | Holly A Clark | Nurse Practitioner | 2320 High St, Blue Island, IL 60406-2426 | 2005-10-05 |
| 1801273362 | Jaydeep Khudai | Family Medicine | 2320 High St, Blue Island, IL 60406-2426 | 2015-05-04 |
| 1902249105 | Syed A Ahmed | Podiatrist | 2320 High St, Blue Island, IL 60406-2426 | 2013-04-08 |
| 1215240981 | Stefanie A Drozd | Nurse Practitioner | 2320 High St, Blue Island, IL 60406-2426 | 2010-07-22 |
| 1003132549 | Vikas Desai | Urology | 2320 High St, Blue Island, IL 60406-2426 | 2010-04-08 |
| 1497983928 | Noreen B Keleher | Physician Assistant | 2320 High St, Blue Island, IL 60406-2426 | 2009-06-23 |
| 1558502245 | Alfonso Mejia-zelaya | Obstetrics & Gynecology | 2320 High St, Blue Island, IL 60406-2426 | 2009-03-10 |
| 1932349040 | Francisco Pereiro | Family Medicine | 2320 High St, Blue Island, IL 60406-2426 | 2009-03-02 |
| 1740438050 | Sophia A Macarol | Physician Assistant | 2320 High St, Blue Island, IL 60406-2426 | 2008-08-29 |
| 1992901300 | Umair Khalid Nazeer | Internal Medicine | 2320 High St, Blue Island, IL 60406-2426 | 2007-06-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1942842810 | Blue Island Smiles PC | Dentist | 12059 Western Avenue, Blue Island, IL 60406 | 2019-10-12 |
| 1609438738 | Maisha Safford | Developmental Therapist | 2262 W. 120th Place, Blue Island, IL 60406 | 2019-06-28 |
| 1891279709 | Renjith Thomas | Physical Therapy Assistant | Therapy Department, 1546 W Water Stret, Blue Island, IL 60406 | 2018-09-18 |
| 1982182994 | Lifehouse Health Group,llc | Clinic/Center | 14127 Levitt Ave, Dixmoor, IL 60406 | 2018-08-01 |
| 1063923159 | Sarah Lynn Presser | Speech-Language Pathologist | 2975 W Broadway, Blue Island, IL 60406 | 2017-10-17 |
| 1174070676 | Aunt Martha's Youth Service Center | Clinic/Center | 12139 S. Western Ave, Blue Island, IL 60406 | 2016-09-01 |
| 1427429141 | Pamela Kilcrease | Case Manager/Care Coordinator | 2247 119th Street, Apt 6, Blue Island, IL 60406 | 2015-10-08 |
| 1639587025 | D2 Dental At Oak Street, P.C. | Dentist | 3046 West 127th Street, Blue Island, IL 60406 | 2014-07-29 |
| 1700299658 | Daniel Ahrens | Optometrist | 13114 S Western Ave, Blue Island, IL 60406 | 2014-06-09 |
| Find all providers in zip 60406 | ||||
| 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 |
|---|---|---|---|---|
| 1063922854 | Anthony Edward Falcon | Physician Assistant | 12935 Gregory St, Blue Island, IL 60406-2428 | 2017-10-05 |
| 1083064299 | Steven Kluck | Physician Assistant | 12935 Gregory St, Blue Island, IL 60406-2428 | 2016-06-18 |
| 1104285196 | Stevie Funk | Physician Assistant | 12935 Gregory St, Blue Island, IL 60406-2428 | 2016-02-18 |
| 1053747816 | Sarah W. Brooks | Physician Assistant | 12935 Gregory St, Blue Island, IL 60406-2428 | 2013-09-24 |
| 1497983928 | Noreen B Keleher | Physician Assistant | 2320 High St, Blue Island, IL 60406-2426 | 2009-06-23 |
| 1861419384 | Karen T Stadnicki | Physician Assistant | 2320 High St, Blue Island, IL 60406-2426 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063010924 | Mckenzie Youngblood | Physician Assistant | 28653 Wren Ln, Jerseyville, IL 62052-6501 | 2020-10-13 |
| 1548877400 | Shawn Milhauser | Physician Assistant | 1014 N Mill St, Pontiac, IL 61764-1332 | 2020-09-25 |
| 1982210654 | Brittany Michelle Weber | Physician Assistant | 525 E Congress Pkwy Ste 200, Crystal Lake, IL 60014-6271 | 2020-09-18 |
| 1003421603 | Logan M Barkley | Physician Assistant | 2560 24th St Ste 201, Rock Island, IL 61201-5390 | 2020-09-10 |
| 1336753342 | Navneet Kaur Bamrah | Physician Assistant | 11316 S Highland Dr, Plainfield, IL 60585-1581 | 2020-09-07 |
| 1306450424 | Annie Mannancheril | Physician Assistant | 9114 Waukegan Rd, Morton Grove, IL 60053-2135 | 2020-09-04 |
| 1508470709 | Bryan Ying Wong | Physician Assistant | 3420 S Morgan St Apt 2e, Chicago, IL 60608-6904 | 2020-09-04 |
| 1386256402 | Emma Schmidt | Physician Assistant | 20 Haverton Ct, Streamwood, IL 60107-1682 | 2020-08-19 |
| 1063024388 | Alyson Dyck | Physician Assistant | 2540 Health Services, Ssb Student Services Building, Normal, IL 61790-2540 | 2020-08-18 |
| 1649882192 | Anna Marie Phillips | Physician Assistant | 5337 Main St, Skokie, IL 60077-2029 | 2020-08-17 |
| Find all providers with the same taxonomy | ||||
| City | BLUE ISLAND |
| Zip Code | 60406 |
Please comment or provide details below to improve the information on JACLYN L MIS.
| 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.