MR. JACOB COUGHLIN (NPI# 1396025805) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396025805 |
| Entity Type | Individual |
| Full Name | MR. JACOB COUGHLIN |
| Credential | PA-C |
| Practice Address |
4613 W Main St Ste A Kalamazoo MI 49006-2698 |
| Mailing Address |
6010 Gull Rd Kalamazoo MI 49048-9452 |
| Practice Telephone | 2694888672 |
| Practice Fax Number | 2694888673 |
| Mailing Telephone | 2693854671 |
| Mailing Fax Number | 2693859614 |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2020-10-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
5601006106 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6010 Gull Rd, Kalamazoo, MI 490489452 | 2693854671 | 2693859614 |
| Street Address |
4613 W MAIN ST STE A |
| City | KALAMAZOO |
| State | MI |
| Zip Code | 49006-2698 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013947522 | Desmonda L Brady | Internal Medicine | 4613 W Main St Ste A, Kalamazoo, MI 49006-2698 | 2006-07-03 |
| 1215344197 | Brigitte Jacqueline Engelmann | Internal Medicine | 4613 W Main St Ste A, Kalamazoo, MI 49006-2698 | 2014-07-12 |
| 1053722199 | Deborah Faling | Social Worker | 4613 W Main St Ste A, Kalamazoo, MI 49006-2698 | 2014-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013455989 | Lauren Gentry | Counselor | 213 S. Kendall Apt 201, Kalamazoo, MI 49006 | 2017-02-10 |
| 1588055768 | Rashida Al-gharib | Counselor | 10107 Boswell Lane, Kalamazoo, MI 49006 | 2015-02-10 |
| 1174913420 | Teesha Lynn Bancroft | Specialist | 329 S Sage St, Kalamazoo, MI 49006 | 2015-01-26 |
| 1801293493 | Ayaz Jaffer | Pharmacist | 5100 Century Avenue, Kalamazoo, MI 49006 | 2014-11-25 |
| 1609207695 | Karen Irene Zantjer | Occupational Therapist | 2575 N Drake, Tendercare Westwood, Kalamazoo, MI 49006 | 2013-12-02 |
| 1629313614 | Jessica Korneder | Behavioral Analyst | 3621 Kenbrooke Court, Kalamazoo, MI 49006 | 2012-12-03 |
| 1508101635 | Gerald Lamont Brooks | Counselor | 4017 W. Main Suite 100, Kalamazoo, MI 49006 | 2012-11-29 |
| 1932356979 | Joy Ann Mcgrath | Occupational Therapist | 1400 North Drake Road, Friendship Village of Kalamazoo, Kalamazoo, MI 49006 | 2008-08-21 |
| 1306901103 | Frederick G Greaves | Psychologist | 4031 W Main, Kalamazoo, MI 49006 | 2006-12-22 |
| 1629162300 | John F Hemmer | Social Worker | 1530 Nichols Road, Kalamazoo, MI 49006 | 2006-10-03 |
| Find all providers in zip 49006 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073057725 | Zachary Turk Harling | Physician Assistant | 2340 Waite Ave, Kalamazoo, MI 49008-1722 | 2016-12-15 |
| 1063961860 | Christine Murphy Lee | Physician Assistant | 6565 West Main St, Westside Family Medical Center, P.c, Kalamazoo, MI 49009 | 2016-09-22 |
| 1831470285 | Kalmazoo Gastroenterology Hepatology and Digestive Health Center | Physician Assistant | 1535 Gull Rd Ste 105, Kalamazoo, MI 49048-1630 | 2011-08-30 |
| 1922321322 | Lisa Marie Cotten | Physician Assistant | 4658 Silverleaf Ln, Kalamazoo, MI 49004-3179 | 2010-03-12 |
| 1043457534 | Carrie Ann Assenmacher | Physician Assistant | 1820 Shaffer Street, Kalamazoo, MI 49048-1604 | 2009-01-21 |
| 1801083126 | Jaclyn Frances Stoddard | Physician Assistant | 6565 West Main St., Kalamazoo, MI 49009 | 2007-10-01 |
| 1811085475 | James Bryon Newton | Physician Assistant | 4249 Pine Knoll Ave, Kalamazoo, MI 49004-9506 | 2006-10-10 |
| 1164490207 | William J Klerk Jr. | Physician Assistant | 1820 Shaffer St, Kalamazoo, MI 49048-1604 | 2006-03-14 |
| 1912999012 | Wayne Gerard Augustyniak | Physician Assistant | 2889 South 11th Street, Kalamazoo, MI 49009-2123 | 2005-08-16 |
| 1700880200 | Joseph Williams | Physician Assistant | 4613 W Main St, Ste. B, Kalamazoo, MI 49006-2645 | 2005-06-13 |
| Find all providers in KALAMAZOO | ||||
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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.