JESSICA G LUCKENBILL (NPI# 1174873103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174873103 |
| Entity Type | Individual |
| Full Name | JESSICA G LUCKENBILL |
| Credential | PA |
| Practice Address |
9000 N Main St Suite 200 Englewood OH 45415-1180 |
| Practice Telephone | 9378365555 |
| Practice Fax Number | 9378367518 |
| Mailing Telephone | 9378365555 |
| Mailing Fax Number | 9378367518 |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2015-07-11 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 50.003591 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0074453 | 05 |
| Street Address |
9000 N MAIN ST SUITE 200 |
| City | ENGLEWOOD |
| State | OH |
| Zip Code | 45415-1180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043824725 | Benjamin Deloss Mishler | Family Medicine | 9000 N Main St, Englewood, OH 45415-1180 | 2020-09-01 |
| 1992313431 | Chris Ticknor | Pharmacist | 9000 N Main St, Englewood, OH 45415-1180 | 2020-07-21 |
| 1134744378 | Stacey Michelle Callison | Nurse Practitioner | 9000 N Main St, Englewood, OH 45415-1180 | 2020-06-13 |
| 1417576299 | Susan Marie Knapke | Dietitian, Registered | 9000 N Main St, Englewood, OH 45415-1180 | 2020-04-13 |
| 1215556071 | Lindsay Nicole Schultz | Dietitian, Registered | 9000 N Main St, Englewood, OH 45415-1180 | 2020-04-13 |
| 1306352216 | Thomas J Kroner | Pharmacist | 9000 N Main St, Englewood, OH 45415-1180 | 2017-12-15 |
| 1730620709 | Gregory Sutton | Specialist/Technologist | 9000 N Main St, Englewood, OH 45415-1180 | 2017-03-10 |
| 1598201584 | Janette E Dale | Nurse Practitioner | 9000 N Main St, Englewood, OH 45415 | 2017-01-13 |
| 1124560016 | Amy Renee Letts | Nurse Practitioner | 9000 N Main St, Suite 305, Englewood, OH 45415-1180 | 2016-11-09 |
| 1679024475 | Anne Antalovich | Audiologist | 9000 N Main St, Suite 319, Englewood, OH 45415-1180 | 2016-10-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457881062 | Angelique Oluyitan | Registered Nurse | 50 Granite Dr, Dayton, OH 45415 | 2017-06-15 |
| 1255869244 | Sherry Marie Buchanan | Occupational Therapy Assistant | 140 Ewoodbury Dr, Dayton, OH 45415 | 2017-06-02 |
| 1417328972 | Thomas Riddell | Hearing Instrument Specialist | 5525 N. Main St, Dayton, OH 45415 | 2015-10-09 |
| 1932448537 | Mory Summer | General Practice | 141 Trailwoods Dr., Dayton, OH 45415 | 2013-02-04 |
| 1184909095 | Yolanda Jean Jenkins | Registered Nurse | 6339 Afton Drive, Dayton, OH 45415 | 2011-10-12 |
| 1023392560 | Megan E Betts | Specialist/Technologist, Other | 9000 N Main St. Ste 303, Dayton, OH 45415 | 2011-10-03 |
| 1356655195 | Gwendolyn L. Warren | Massage Therapist | 8393 N. Main St., Ste B, Dayton, OH 45415 | 2010-08-04 |
| 1811141559 | Dayton Physicians, LLC | Durable Medical Equipment & Medical Supplies | 9000 N Main St Suite 333, Dayton, OH 45415 | 2008-11-07 |
| 1730331224 | Joel Metze | Obstetrics & Gynecology | 9000 N Main St Ste 232, Englewood, OH 45415 | 2008-10-16 |
| 1023236247 | James Otis Hurst | Dentist | 9000 N. Main Street, Suite 207, Dayton, OH 45415 | 2007-04-23 |
| Find all providers in zip 45415 | ||||
| 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 |
|---|---|---|---|---|
| 1184221624 | Jamie Marie Shriver | Physician Assistant | 15859 E Jamison Dr Apt 19308, Englewood, CO 80112-4681 | 2020-10-07 |
| 1104472679 | Lee K Maloney | Physician Assistant | 9570 S Kingston Ct Ste 100, Englewood, CO 80112-6004 | 2019-08-12 |
| 1376038240 | Elizabeth Ann Dickason | Physician Assistant | 9094 East Mineral Avenue, #100, Englewood, CO 80112 | 2018-06-24 |
| 1669963146 | Deborah G. Aragon | Physician Assistant | 6229 S. Iola Wy, Englewood, CO 80111 | 2018-05-21 |
| 1780110445 | Amanda Lewis | Physician Assistant | 6086 S Iola Way, Englewood, CO 80111-5705 | 2017-05-02 |
| 1649703307 | Tina Marie Jacobs | Physician Assistant | 304 Inverness Way S Ste 312, Englewood, CO 80112-5826 | 2017-04-09 |
| 1134662992 | Orli Feder | Physician Assistant | 60 E Linden Ave, Apt: 5a, Englewood, NJ 07631-3667 | 2016-11-28 |
| 1700258415 | Jenna Lynn Easton | Physician Assistant | 3511 S Clarkson St # 80113, Englewood, CO 80113-3916 | 2015-10-21 |
| 1013257385 | Carolyn Edlund | Physician Assistant | 699 S Indiana Ave, Englewood, FL 34223-3705 | 2013-02-25 |
| 1780933978 | Robert Aaron Prevatt | Physician Assistant | 88 Inverness Cir E Unit J105, Englewood, CO 80112-5527 | 2012-09-04 |
| Find all providers in ENGLEWOOD | ||||
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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.