JACOB (JAKE) WILLIAM CONDREN (NPI# 1265971865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265971865 |
| Entity Type | Individual |
| Full Name | JACOB (JAKE) WILLIAM CONDREN |
| Credential | PA-C |
| Practice Address |
1155 W Parkview St Suite 2d Bolivar MO 65613-8279 |
| Mailing Address |
1500 N Oakland Ave Bolivar MO 65613-3011 |
| Practice Telephone | 4177772663 |
| Practice Fax Number | 4177772666 |
| Mailing Telephone | 4173266000 |
| Mailing Fax Number | 4173286338 |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2017-02-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1155 W PARKVIEW ST SUITE 2D |
| City | BOLIVAR |
| State | MO |
| Zip Code | 65613-8279 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679531545 | Walter Wayne Wolf IIi | Surgery | 1155 W Parkview St, Suite 1f, Bolivar, MO 65613-8279 | 2006-05-02 |
| 1073829925 | Troy Morrison | Orthopaedic Surgery | 1155 W Parkview St, Suite 2d, Bolivar, MO 65613-8279 | 2010-08-28 |
| 1285956797 | Matthew Campbell Ericksen | Otolaryngology | 1155 W Parkview St, Suite 2j, Bolivar, MO 65613-8279 | 2010-02-25 |
| 1235395765 | Citizens Memorial Healthcare Clinics | Durable Medical Equipment & Medical Supplies | 1155 W Parkview St, Suite 2d, Bolivar, MO 65613-8279 | 2008-08-04 |
| 1851468987 | Martin S. Tyson | Surgery | 1155 W Parkview St, Suite 1g, Bolivar, MO 65613-8279 | 2006-11-30 |
| 1508979477 | Kenneth Ronald Smith | Orthopaedic Surgery | 1155 W Parkview St, Suite 2d, Bolivar, MO 65613-8279 | 2006-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301552 | Casablanca Care Center, LLC | Home Health | 524 S. Albany Avenue, Bolivar, MO 65613 | 2020-09-18 |
| 1669087045 | Revive Medical LLC | Durable Medical Equipment & Medical Supplies | 5000, S Scenic, Bolivar, MO 65613 | 2020-09-11 |
| 1669097119 | Melanie Nicole Beckham | Nurse Practitioner | 1100 South Springfield Ave, Suite B, Bolivar, MO 65613 | 2020-06-10 |
| 1932754744 | Caitlin M Williams | Specialist/Technologist | 1260 S Pike Avenue, Bolivar, MO 65613 | 2019-08-08 |
| 1073022406 | Jacquelyn Rose Kemnic | Dietitian, Registered | Heart Center, 1500 N Oakland Ave, Willard, MO 65613 | 2017-09-28 |
| 1164897161 | Ozarks Resource Group | Clinic/Center | 203 E. Broadway St., Bolivar, MO 65613 | 2015-12-02 |
| 1962895292 | Professional Christian Counseling | Counselor | 4888 S 139th Road, Bolivar, MO 65613 | 2015-03-11 |
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1053712109 | Citizens Memorial Hospital District | Pharmacy | 1301-b North Oakland, Bolivar, MO 65613 | 2014-09-09 |
| 1740680453 | Jamee M Stimpson | Occupational Therapist | 454 S. Main Avenue, Bolivar, MO 65613 | 2014-08-29 |
| Find all providers in zip 65613 | ||||
| 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 |
|---|---|---|---|---|
| 1073916573 | Scott Leslie Dennis | Physician Assistant | 1500 North Oakland Ave, Citizens Memorial Hospital, Bolivar, MO 65613 | 2014-09-29 |
| 1366074817 | Retha Marceleen Dawes | Physician Assistant | 1155 W Parkview St Ste 2d, Bolivar, MO 65613-7800 | 2020-02-12 |
| 1700427358 | Micah Miller | Physician Assistant | 1500 N Oakland Ave, Bolivar, MO 65613-3099 | 2019-10-04 |
| 1598244618 | Chloe Jo Michelle Wingert | Physician Assistant | 1501 N Oakland Ave, Bolivar, MO 65613-3020 | 2018-08-09 |
| 1821529520 | Melissa Gibbs | Physician Assistant | 1500 N Oakland Ave, Bolivar, MO 65613-3011 | 2017-03-23 |
| 1992123889 | Caressa R Patel | Physician Assistant | 1500 N. Oakland, Bolivar, MO 65613-3011 | 2014-03-28 |
| 1417202425 | Anjali M Edson | Physician Assistant | 1501 N Oakland Ave, Bolivar, MO 65613-3020 | 2012-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639779341 | Andrew Hecht | Physician Assistant | 13131 Tesson Ferry Rd Ste 105, Saint Louis, MO 63128-3887 | 2020-10-30 |
| 1396352860 | Alexis Lindsey | Physician Assistant | 5629 Bischoff Ave, Saint Louis, MO 63110-2929 | 2020-09-28 |
| 1194334094 | Olivia Faeth Langley | Physician Assistant | 507 Kenilworth Ln, Ballwin, MO 63011-2433 | 2020-07-27 |
| 1770192759 | Clara Boo Chai | Physician Assistant | General Leonard Wood Army Community Hospital, 4430 Missouri Ave, #1267, Fort Leonard Wood, MO 65473 | 2020-07-27 |
| 1942824339 | Jett Elena Mcguire | Physician Assistant | 2200 Locust St Apt 506, Saint Louis, MO 63103-1532 | 2020-06-02 |
| 1356965602 | Katherine Anne Hill | Physician Assistant | 3619 Whispering Ridge Ln, Saint Louis, MO 63129-2247 | 2020-06-02 |
| 1922629559 | Tiffany Nuno | Physician Assistant | 621 Tipton St, Sullivan, MO 63080-2152 | 2020-05-06 |
| 1477174944 | Sarah Christenson | Physician Assistant | 4515 Walnut St Apt 221d, Kansas City, MO 64111-7731 | 2020-05-06 |
| 1326669516 | Kayla Bergmann | Physician Assistant | 58 W Glendale Rd, Saint Louis, MO 63119-4054 | 2020-04-29 |
| 1962023341 | Kaitlin Nicole Sutten | Physician Assistant | 6711 Nw Evelyn St, Kansas City, MO 64151-2115 | 2020-04-27 |
| 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.