JAN MIRIAM JACOB-WICKLAND (NPI# 1508980541) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508980541 |
| Entity Type | Individual |
| Full Name | JAN MIRIAM JACOB-WICKLAND |
| Credential | PA-C |
| Practice Address |
615 S New Ballas Rd Dept Of Saint Louis MO 63141-8221 |
| Mailing Address |
1054 Big Bend Station Dr Manchester MO 63088-1429 |
| Practice Telephone | 3142516000 |
| Practice Fax Number | 6363867679 |
| Mailing Telephone | 6368611102 |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2019-02-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 119559 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Barnes Jewish Hospital Plz, Saint Louis, MO 631101003 | 3144548134 |
| Street Address |
615 S NEW BALLAS RD DEPT OF |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912973819 | Michael J Manalo | Anesthesiology | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2006-02-28 |
| 1669022067 | Danielle Ravancho | Anesthesiologist Assistant | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-09-17 |
| 1942852785 | John Martin Stafford | Anesthesiologist Assistant | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-07-11 |
| 1639736754 | Robert T Hamblin | Anesthesiologist Assistant | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-05-23 |
| 1245897388 | Joseph A Almengor | Student in an Organized Health Care Education/Training Program | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-05-23 |
| 1194382234 | Elias A Valerio | Anesthesiologist Assistant | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-05-23 |
| 1134693385 | Jamie Deubel | Nurse Anesthetist, Certified Registered | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-01-21 |
| 1538633938 | Kaitlyn Brown | Nurse Anesthetist, Certified Registered | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2019-01-18 |
| 1902394836 | Taylor Paden | Anesthesiologist Assistant | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141-8221 | 2018-04-26 |
| 1467957829 | Adam Edwards | Anesthesiologist Assistant | 615 S New Ballas Rd Dept Of, Saint Louis, MO 63141 | 2018-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| 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 |
|---|---|---|---|---|
| 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 |
| 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 |
| 1326669516 | Kayla Bergmann | Physician Assistant | 58 W Glendale Rd, Saint Louis, MO 63119-4054 | 2020-04-29 |
| 1023638038 | Laura Ann Humphrey | Physician Assistant | Allied Health Building 3437 Caroline Street, Room 3015, Saint Louis, MO 63104 | 2020-04-20 |
| 1477172237 | Allison Mcniell | Physician Assistant | 3853 Mcdonald Ave # 1f, Saint Louis, MO 63116-4716 | 2020-04-13 |
| 1922627728 | Allissa Speiser | Physician Assistant | 3437 Caroline St Ste 3082, Saint Louis, MO 63104-1111 | 2020-04-11 |
| 1578182564 | Alexander Charles Greff | Physician Assistant | 6416 Oakland Ave Apt 306, Saint Louis, MO 63139-3226 | 2020-04-10 |
| 1043839061 | Andrew Chida | Physician Assistant | 2050 Lafayette Ave Apt 1e, Saint Louis, MO 63104-2529 | 2020-04-09 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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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.