ERIC F STAKEBAKE (NPI# 1619215738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619215738 |
| Entity Type | Individual |
| Full Name | ERIC F STAKEBAKE |
| Credential | MPAS, PA-C |
| Practice Address |
4650 Harrison Blvd Ogden UT 84403-4303 |
| Practice Telephone | 8014753200 |
| Practice Fax Number | 8014753204 |
| Mailing Telephone | 8014753000 |
| Mailing Fax Number | 8014753001 |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2014-08-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2853911206 | UT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4650 HARRISON BLVD |
| City | OGDEN |
| State | UT |
| Zip Code | 84403-4303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588651152 | Nadim B Bikhazi | Otolaryngology | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2005-09-29 |
| 1174142608 | Jordan Roe | Pharmacist | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2020-04-14 |
| 1700305265 | Molli A Neilson | Physician Assistant | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2017-09-15 |
| 1255884037 | Nancy S Shina | Nurse Practitioner | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2016-07-28 |
| 1245630078 | Mindy K Robert | Nurse Practitioner | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2014-08-28 |
| 1366884306 | Leigh Anna Jarman | Nurse Practitioner | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2013-07-18 |
| 1396184487 | Gregory A Reeves | Physician Assistant | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2013-06-21 |
| 1952656738 | Lea D Hedstrom | Physician Assistant | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2012-07-18 |
| 1083976815 | Megan C Walker | Speech-Language Pathologist | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2012-06-07 |
| 1336413939 | Lane Bart Christensen | Nurse Practitioner | 4650 Harrison Blvd, Ogden, UT 84403-4303 | 2012-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235744632 | Megan Louise Larkins | Specialist/Technologist | 4000 Brinker Ave. The Apartments., Apartment 15, Ogden, UT 84403 | 2020-09-11 |
| 1154959062 | Joshua Clifford Hansen | Student in an Organized Health Care Education/Training Program | 4403 Harrison Boulevard, Ste A700, Ogden, UT 84403 | 2020-03-28 |
| 1346895935 | Positional Release Therapy Institute LLC | Specialist/Technologist | 1702 E. 5600 S., Ogden, UT 84403 | 2019-08-09 |
| 1841842077 | Braken Wooden | Chiropractor | 1893 Skyline Dr., Suite 204, South Ogden, UT 84403 | 2019-07-09 |
| 1023670569 | Wasatch Advanced Dental Care LLC | Dentist | 3590 Harrison Blvd Suite #1, Ogden, UT 84403 | 2019-07-05 |
| 1194237636 | Marci Niemeyer | Physician Assistant | 5929 Fashion Point Dr Ste 101, South Ogden, UT 84403 | 2017-10-24 |
| 1578081949 | Stephanie Jensen | Specialist/Technologist | 1473 36th Street, Ogden, UT 84403 | 2017-09-06 |
| 1891213385 | Forrest Sutherland | Specialist/Technologist | 1075 E 41st St., Ogden, UT 84403 | 2017-09-05 |
| 1184159022 | Nicole Lee Van Tassell | In Home Supportive Care | 1496 East 5600 South, Unit 6, Ogden, UT 84403 | 2017-04-28 |
| 1265889166 | Modern Dental Professionals Ut, PC | Dentist | 5974 S. Fashion Pointe Drive, Suite 210, South Ogden, UT 84403 | 2016-05-20 |
| Find all providers in zip 84403 | ||||
| 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 |
|---|---|---|---|---|
| 1164020830 | Abbey Coburn | Physician Assistant | 6028 S Ridgeline Dr Ste 200, Ogden, UT 84405-6906 | 2020-10-14 |
| 1578030078 | James A Hardy IIi | Physician Assistant | 1900 Washington Blvd Ste 104, Ogden, UT 84401-6850 | 2018-11-01 |
| 1902273311 | Austin Okelberry | Physician Assistant | 4403 Harrison Blvd Ste 2455, Ogden, UT 84403-3330 | 2015-09-01 |
| 1114321361 | Mckel Anne Roskelley | Physician Assistant | 1355 W 3400 S, Ogden, UT 84401-3376 | 2014-10-17 |
| 1942450580 | Jonathan Winkfield | Physician Assistant | 6028 S Ridgeline Dr Ste 201, Ogden, UT 84405-6908 | 2008-09-19 |
| 1609039825 | Kyle Marlin Hoffmann | Physician Assistant | 735 N 950 E, Ogden, UT 84404-3885 | 2008-07-08 |
| 1851480982 | Billi Tsuya | Physician Assistant | 150 N Washington Blvd, Ogden, UT 84404-4074 | 2006-10-12 |
| 1205923760 | Craig Pulley | Physician Assistant | 4403 Harrison Blvd Ste 2400, Ogden, UT 84403-3297 | 2006-10-06 |
| 1437246998 | Scott D Ford | Physician Assistant | 5957 South Fashion Point Drive, Ogden, UT 84403 | 2006-10-06 |
| 1033177837 | Christa M Black | Physician Assistant | 5825 Harrison Blvd, Ogden, UT 84403-4316 | 2006-05-02 |
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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.