JACYLYN DENISE WAHL (NPI# 1245715309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245715309 |
| Entity Type | Individual |
| Full Name | JACYLYN DENISE WAHL |
| Credential | MPAS, PA-C |
| Practice Address |
12970 W Bluemound Rd Ste 200 Elm Grove WI 53122-2607 |
| Practice Telephone | 2627801020 |
| Practice Fax Number | 2627801022 |
| Mailing Telephone | 2627801020 |
| Mailing Fax Number | 2627801022 |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2020-04-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 4815 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1650 Cochrane Cir, Fort Carson, CO 809134613 | 7195267000 | |
| 30488 Milford Rd, New Hudson, MI 481658583 | 2484374625 | |
| 27204 Beck Rd, Novi, MI 48374 | 2485133719 |
| Street Address |
12970 W BLUEMOUND RD STE 200 |
| City | ELM GROVE |
| State | WI |
| Zip Code | 53122-2607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215073747 | Judy Wang Lue Bertoni | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2007-01-30 |
| 1861004848 | Michaela Klimko | Student in an Organized Health Care Education/Training Program | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2020-08-20 |
| 1285257683 | Elizabeth Johnson | Marriage & Family Therapist | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2020-05-20 |
| 1013539097 | Michael Alexander Baumhardt | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2020-05-12 |
| 1902449267 | Jennifer Sumiec | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2019-10-18 |
| 1023669926 | Susan Marie Condon | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2019-09-23 |
| 1104473651 | Stephanie Anne Zettel | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2019-08-20 |
| 1770143554 | Logan A Hamel | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2019-06-14 |
| 1144888942 | Teresa Rose Mccabe | Social Worker | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2019-06-05 |
| 1386128932 | Elisabeth Gehrke | Counselor | 12970 W Bluemound Rd Ste 200, Elm Grove, WI 53122-2607 | 2018-09-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831797687 | Brian Gordon Wisniewski | Hearing Instrument Specialist | 13000 W. Bluemound Road, Elm Grove, WI 53122 | 2020-10-14 |
| 1124279161 | Otto Albrecht Wiegmann | Ophthalmology | 1945 Westmoor Ter, Elm Grove, WI 53122 | 2008-10-08 |
| 1912161266 | Kaaya Medicine | Internal Medicine | 14840 Jueau Blvd, Elm Grove, WI 53122 | 2008-07-16 |
| 1205050903 | Actualized Clinical Services Consulting, Inc. | Psychologist | 820 Brinsmere Drive, Elm Grove, WI 53122 | 2007-04-12 |
| 1487793345 | Lynn Joy Gauger | Social Worker | 740 North Pilgrim Parkway, Suite 206, Elm Grove, WI 53122 | 2007-02-06 |
| 1336218957 | Bette L Frangesch | Nurse Practitioner | 13105 E Watertown Plank Rd, Unite Theresa 2, Elm Grove, WI 53122 | 2006-11-07 |
| 1043398464 | Carol Therese Haughey | Family Medicine | 1050 Legion Drive, Elm Grove, WI 53122 | 2006-11-02 |
| 1700972908 | Christos Counseling | Social Worker | 12970 W. Bluemound Road, #105, Elm Grove, WI 53122 | 2006-10-05 |
| 1932138245 | Tammy M Groszczyk | Counselor | 890 Elm Grove Rd Ste 6, Elm Grove, WI 53122 | 2006-06-30 |
| 1689272437 | James Joseph Brinks | Hearing Instrument Specialist | 13000 W. Bluemound Road, Elm Grove, WI 53122 | 2020-10-14 |
| Find all providers in zip 53122 | ||||
| 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 |
|---|---|---|---|---|
| 1366060295 | Sarah Anne Cook | Physician Assistant | 850 Brinsmere Dr, Elm Grove, WI 53122-2101 | 2020-07-07 |
| 1831354075 | Tim Gengembre | Physician Assistant | 1650 Pilgrim Pkwy, Elm Grove, WI 53122-1531 | 2008-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043811409 | Kristen T Razner | Physician Assistant | 2500 E Capitol Dr # 3700, Appleton, WI 54911-8735 | 2020-11-03 |
| 1659986677 | Jordana Butler | Physician Assistant | 2105 E Enterprise Ave # 101, Appleton, WI 54913-7862 | 2020-09-15 |
| 1952916108 | Nicholas Allan Lueddecke | Physician Assistant | 101709 Fence Rd, Abbotsford, WI 54405-5400 | 2020-09-14 |
| 1073127049 | Dana Van De Hey | Physician Assistant | 616 White Birch Ct, Appleton, WI 54915-4516 | 2020-09-07 |
| 1386257194 | Harrison R Pham | Physician Assistant | 214 E Florida St Apt 526, Milwaukee, WI 53204-1657 | 2020-08-31 |
| 1366055063 | Clai Bishop Catto | Physician Assistant | 902c Tainter St, Menomonie, WI 54751-1546 | 2020-08-24 |
| 1003434978 | Benjamin Alton Cuvelier | Physician Assistant | 132 Cambridge Ave Apt 407, Waukesha, WI 53188-4788 | 2020-07-08 |
| 1275159428 | Breanna Evert | Physician Assistant | 2320 Parklawn Dr # C111, Waukesha, WI 53186-2954 | 2020-06-23 |
| 1376168443 | Sadie Kolodziej | Physician Assistant | 401 Dewey Dr, Stevens Point, WI 54482-9655 | 2020-06-14 |
| 1013532886 | Amanda Bruggink | Physician Assistant | 6045 S Karrington Ln, New Berlin, WI 53151-8751 | 2020-06-08 |
| Find all providers with the same taxonomy | ||||
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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.