MR. JESSE ROBERT GUSTAFSON (NPI# 1629549852) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629549852 |
| Entity Type | Individual |
| Full Name | MR. JESSE ROBERT GUSTAFSON |
| Credential | PA |
| Practice Address |
117 E Kings Hwy Eden NC 27288-5201 |
| Mailing Address |
200 Corporate Blvd Lafayette LA 70508-3870 |
| Practice Telephone | 3366239711 |
| Practice Fax Number | 3366236182 |
| Mailing Telephone | 8008939698 |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2019-02-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 244665 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861888968 | Jesse Gustafson | Behavioral Analyst | 9901 Ne 7th Ave, Ste C-116, Vancouver, WA 98685-4523 | 2015-04-15 |
| Street Address |
117 E KINGS HWY |
| City | EDEN |
| State | NC |
| Zip Code | 27288-5201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326048810 | Unc Rockingham Health Care, Inc. | General Acute Care Hospital | 117 E Kings Hwy, Eden, NC 27288-5201 | 2005-07-26 |
| 1528545399 | Unc Rockingham Health Care, Inc. | Anesthesiology | 117 E Kings Hwy, Eden, NC 27288-5201 | 2018-07-25 |
| 1366929135 | Unc Rockingham Health Care, Inc. | Nurse Anesthetist, Certified Registered | 117 E Kings Hwy, Eden, NC 27288-5201 | 2018-07-25 |
| 1275010043 | Unc Rockingham Health Care, Inc. | Surgery | 117 E Kings Hwy, Eden, NC 27288-5201 | 2018-07-25 |
| 1710477849 | Mary Robertson Lafar | Physical Therapy Assistant | 117 E Kings Hwy, Eden, NC 27288-5201 | 2018-05-15 |
| 1174036495 | Melonie Deon Davis | Counselor | 117 E Kings Hwy, Eden, NC 27288-5201 | 2017-11-08 |
| 1457862963 | Katheryn Goodman Hubbard | Social Worker | 117 E Kings Hwy, Eden, NC 27288-5201 | 2017-10-24 |
| 1407203888 | Jonathan Kenton Tackett | Emergency Medicine | 117 E Kings Hwy, Eden, NC 27288-5201 | 2016-05-16 |
| 1164886834 | Trey Washington | Occupational Therapist | 117 E Kings Hwy, Eden, NC 27288-5201 | 2016-04-08 |
| 1356706519 | Michael V Stehlik | Pharmacist | 117 E Kings Hwy, Eden, NC 27288-5201 | 2015-12-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639781297 | Bailey Shea Scism | Pharmacist | 103 W Stadium Dr., Eden, NC 27288 | 2020-08-17 |
| 1538640628 | Donnell Corey Brown Jr. | Technician | 519 Orchard Drive, Eden, NC 27288 | 2018-08-27 |
| 1851728182 | Linda Mitchell | Physical Therapy Assistant | 114 E Kings Hwy, Eden, NC 27288 | 2013-10-01 |
| 1033341573 | Central State of The Carolinas, Inc. | Day Training, Developmentally Disabled Services | 229 Cedar St., Eden, NC 27288 | 2009-08-18 |
| 1114186483 | Enrich Cosmetic Center | Internal Medicine | 406 B Thompson St, Eden, NC 27288 | 2008-06-03 |
| 1265630891 | John R. Dabbs Jr. Dc PC | Preferred Provider Organization | 405 Boone Road, Eden, NC 27288 | 2007-07-05 |
| 1235283961 | James Harrison Eggleston | Dentist | 113 West Arbor Lane, Eden, NC 27288 | 2007-01-22 |
| 1962563940 | Barbara Collins Tanner | Nurse Practitioner | 134 North Pierce Street, Morehead High School Student Health Center, Eden, NC 27288 | 2006-12-13 |
| 1285690974 | Robert Maurice Vaughn | Chiropractor | 405 Boone Rd, Eden, NC 27288 | 2006-04-22 |
| 1619930666 | Direct Respiratory Services | Durable Medical Equipment & Medical Supplies | 302a North Pierce Street, Eden, NC 27288 | 2006-04-10 |
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| 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 |
|---|---|---|---|---|
| 1447252648 | William S Boyd | Physician Assistant | 250 W Kings Hwy, Eden, NC 27288-5010 | 2005-06-01 |
| 1801400353 | Alyssa Horton | Physician Assistant | 250 W Kings Hwy, Eden, NC 27288-5010 | 2020-09-02 |
| 1649815283 | Jakalyn Jane Gossett | Physician Assistant | 614 Eaker St, Eden, TX 76837 | 2019-11-07 |
| 1356718712 | Alyssa Michelle Allwardt | Physician Assistant | 250 W Kings Hwy, Eden, NC 27288-5010 | 2015-09-01 |
| 1447673975 | Tiffany Gann | Physician Assistant | 519 S Van Buren Rd, Suite C, Eden, NC 27288-5070 | 2014-02-04 |
| 1275773954 | Eden Internal Medicine Pllc | Physician Assistant | 405 Thompson St, Eden, NC 27288-5045 | 2009-02-20 |
| 1215968763 | Eugene Carmelo Serpe | Physician Assistant | 518 S Van Buren Rd, Ste 3, Eden, NC 27288-5033 | 2006-07-05 |
| 1558363754 | Amy H Boyd | Physician Assistant | 250 W Kings Hwy, Eden, NC 27288-5010 | 2005-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215538459 | Sarah Jane Lamanna | Physician Assistant | 3012 Bristol Creek Dr, Morrisville, NC 27560-7811 | 2020-11-04 |
| 1043819741 | Brad Russell Tolan | Physician Assistant | 211 Pinegate Cir Apt 12, Chapel Hill, NC 27514-2221 | 2020-10-22 |
| 1265030654 | Vanessa Vinson | Physician Assistant | 284 Lower Edgewood Rd, Candler, NC 28715-9285 | 2020-10-16 |
| 1649878810 | Courtney Michelle Watlington | Physician Assistant | 360 N Bennett St, Southern Pines, NC 28387-4813 | 2020-10-11 |
| 1669079034 | Christine Meyer | Physician Assistant | 2523 Creek Ridge Ln, Chapel Hill, NC 27514-7454 | 2020-10-07 |
| 1407453319 | Khyan Waddell | Physician Assistant | 127 Sneed Rd, Enfield, NC 27823-9589 | 2020-10-04 |
| 1053918979 | Amjad Ali | Physician Assistant | 730 Montlieu Ave, High Point, NC 27260-4000 | 2020-10-04 |
| 1104433382 | Aditi Bhattacharjee Sundaresan | Physician Assistant | 131 Mallard Ct, Chapel Hill, NC 27517-9104 | 2020-09-30 |
| 1689281933 | Kathryn Tarulli | Physician Assistant | 600 W Main St Apt 624, Durham, NC 27701-5005 | 2020-09-29 |
| 1205443991 | Kelsey Mendez | Physician Assistant | 105 Basket Oak Dr, Bunnlevel, NC 28323-9141 | 2020-09-26 |
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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.