JACLYN JOY HAKE (NPI# 1497994727) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497994727 |
| Entity Type | Individual |
| Full Name | JACLYN JOY HAKE |
| Credential | PA-C |
| Practice Address |
715 Broadway St Gillespie IL 62033-1166 |
| Practice Telephone | 2178392689 |
| Practice Fax Number | 2178392689 |
| Mailing Telephone | 2178392689 |
| Mailing Fax Number | 2178392689 |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2014-04-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
085003429 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | IL LICENSE | 085003429 | 01 |
| Street Address |
715 BROADWAY ST |
| City | GILLESPIE |
| State | IL |
| Zip Code | 62033-1166 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609870591 | Bruce Frank Weber | Family Medicine | 715 Broadway St, Gillespie, IL 62033-1166 | 2005-06-08 |
| 1245706548 | Samantha Kay Rogers | Nurse Practitioner | 715 Broadway St, Gillespie, IL 62033-1166 | 2018-10-15 |
| 1609238518 | Mary Amanda Pittman | Nurse Practitioner | 715 Broadway St, Gillespie, IL 62033-1166 | 2016-03-22 |
| 1811389935 | Hollie Trettenero | Nurse Practitioner | 715 Broadway St, Gillespie, IL 62033-1166 | 2015-02-26 |
| 1194915074 | Macoupin Family Practice Center, LLP | Family Medicine | 715 Broadway St, Gillespie, IL 62033-1166 | 2007-07-27 |
| 1568652436 | Macoupin Family Practice Centers, LLP | Family Medicine | 715 Broadway St, Gillespie, IL 62033-1166 | 2007-07-27 |
| 1699899070 | Macoupin Family Practice Centers LLP | Family Medicine | 715 Broadway St, Gillespie, IL 62033-1166 | 2007-03-19 |
| 1477586121 | Jason K Manthei | Physician Assistant | 715 Broadway St, Gillespie, IL 62033-1166 | 2006-07-08 |
| 1992709984 | Chris Philip Poirot | Family Medicine | 715 Broadway St, Gillespie, IL 62033-1166 | 2005-06-08 |
| 1417951401 | Brian Lee Quarton | Family Medicine | 715 Broadway St, Gillespie, IL 62033-1166 | 2005-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225596950 | Laura Michelle Halpin | Physical Therapist | 607 Litchfield Road, Gillespie, IL 62033 | 2019-03-12 |
| 1770942716 | Carol Candler | Nurse Practitioner | 109 East Maple Street, Maucoupin County Maple Street Clinic, Gillespie, IL 62033 | 2016-02-18 |
| 1932519618 | Terry Allan | Pharmacist | 113 South Macoupin Street, Gillespie, IL 62033 | 2014-05-02 |
| 1649414558 | Bernadette Kathlene Sobczak | Nurse Practitioner | 807 Broadway, Gillespie, IL 62033 | 2009-04-22 |
| 1376765206 | Sheri Lynne Banovic | Nurse Practitioner | 115 South Macoupin Street, Gillespie, IL 62033 | 2007-05-02 |
| 1215044920 | James Paul Verton | Pharmacist | 120 S Macoupin, Dippold Drug Co Inc, Gillespie, IL 62033 | 2006-08-25 |
| 1427575612 | Beth Lynn Sies | Speech-Language Pathologist | 340 Kelly St, Gillespie, IL 62033 | 2017-08-28 |
| 1356599971 | Julia Terese Ruckman | Social Worker | 109 E Maple St, Gillespie, IL 62033 | 2008-09-08 |
| 1124135835 | Bruce W Hughes | Pharmacist | 120 S Macoupin, Dippold Drug Co Inc, Gillespie, IL 62033 | 2006-08-25 |
| 1407474083 | Staten Family Practice Pllc | Clinic/Center | 500 W Virginia Ave, Gillespie, IL 62033-1025 | 2020-07-09 |
| Find all providers in zip 62033 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707298 | Eliza Ballen | Physician Assistant | 335 Sylvan Rd, Lake Bluff, IL 60044-2562 | 2020-07-21 |
| 1477177947 | Rybecca Janovyak | Physician Assistant | 14432 High Rd, Lockport, IL 60441-9402 | 2020-06-01 |
| 1518591759 | Julie Jenkot | Physician Assistant | 333 N Michigan Ave Fl 14, Chicago, IL 60601-3901 | 2020-02-26 |
| 1801429873 | Hinjal D Jha | Physician Assistant | 22285 N Pepper Rd Ste 409, Lake Barrington, IL 60010-2542 | 2020-02-19 |
| 1770120222 | Alvina Shaikh | Physician Assistant | 4009 Warren Ave, Bellwood, IL 60104-2066 | 2019-12-03 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1538705272 | Bethany Mae Frisby | Physician Assistant | 8630 W Golf Rd, Niles, IL 60714-5600 | 2019-11-18 |
| 1134761984 | Ella-marie Rakowski | Physician Assistant | 25 Acorn Dr, Hawthorn Woods, IL 60047-7407 | 2019-10-14 |
| 1467001859 | Timothy Omotayo Adesanya | Physician Assistant | Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | 2019-09-09 |
| 1518514066 | Victoria Moore | Physician Assistant | 979 W Main St, West Dundee, IL 60118-2088 | 2019-08-20 |
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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.