JEFFREY CHARLES OTIS (NPI# 1649720533) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649720533 |
| Entity Type | Individual |
| Full Name | JEFFREY CHARLES OTIS |
| Credential | PA-C |
| Practice Address |
405 Nebraska Ave E Saint Paul MN 55130-3226 |
| Practice Telephone | 6512456338 |
| Mailing Telephone | 6512456338 |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2016-10-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
405 NEBRASKA AVE E |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55130-3226 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164904587 | Confident Care LLC | In Home Supportive Care | 1040 Arkwright Street, Saint Paul, MN 55130 | 2018-09-01 |
| 1881015253 | Lucas Bosco Wanga | Psychologist | 715 Edgerton Street, Merrick Community Services, St. Paul, MN 55130 | 2014-01-02 |
| 1174865570 | Sarang Patel | Internal Medicine | 401 Phalen Blvd # 41103d, Saint Paul, MN 55130 | 2013-03-23 |
| 1427394501 | Zongxee Lee | Registered Nurse | 1072 Payne Ave, St. Paul, MN 55130 | 2012-12-18 |
| 1740532753 | One Stop Medical Supply Inc | Durable Medical Equipment & Medical Supplies | 1049 Payne Ave Suite C, St Paul, MN 55130 | 2012-10-15 |
| 1689923997 | Alexis Simmons | Counselor | 402 University Ave East, Suite A-127, Saint Paul, MN 55130 | 2012-08-31 |
| 1689804064 | Group Health Plan, Inc. | Durable Medical Equipment & Medical Supplies | 537 Phalen Blvd, Saint Paul, MN 55130 | 2009-07-21 |
| 1477756534 | Chad Everett Christensen | Chiropractor | 1073 Payne Ave, Saint Paul, MN 55130 | 2007-06-07 |
| 1922219021 | Qwik Urgent Care Clinic | Family Medicine | 1239 Payne Avenue, Saint Paul, MN 55130 | 2007-05-24 |
| 1275743981 | Yia Vang | Technician | 1100 Arkwright St., St. Paul, MN 55130 | 2007-05-23 |
| Find all providers in zip 55130 | ||||
| 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 |
|---|---|---|---|---|
| 1588265284 | Foua Vang | Physician Assistant | 689 County Road D E Apt 302, Saint Paul, MN 55117-1263 | 2020-11-08 |
| 1679107841 | Kelsey Locken | Physician Assistant | 2285 University Ave W Unit 161, Saint Paul, MN 55114-1645 | 2020-02-26 |
| 1497395719 | Demitri Nichelle Gockel | Physician Assistant | 750 Otto Ave Unit 2242, Saint Paul, MN 55102-5042 | 2020-01-14 |
| 1245870203 | Ashley Kay Warner | Physician Assistant | 640 Jackson St # 11102f, Saint Paul, MN 55101-2595 | 2020-01-07 |
| 1275171795 | Keith Fertey Moy | Physician Assistant | 594 Montrose Ln, Saint Paul, MN 55116-1158 | 2019-12-16 |
| 1609417757 | Mh 101, PC | Physician Assistant | 1999 Shepard Rd, Saint Paul, MN 55116-3210 | 2019-09-30 |
| 1760048946 | Amity Alice Carlson | Physician Assistant | 1600 University Ave W Ste 205, Saint Paul, MN 55104-3825 | 2019-05-14 |
| 1740747872 | Angela Marie Schlangen | Physician Assistant | 435 Phalen Blvd., Mail Stop 51103c, Saint Paul, MN 55130-5302 | 2019-02-25 |
| 1922590488 | Diane Mcleod | Physician Assistant | Healthpartners Regions Specialty Clinics, 640 Jackson St - Mail Stop 11109e, Saint Paul, MN 55101 | 2018-05-31 |
| 1770986101 | Margaret Augusta Cutter | Physician Assistant | 200 Univeristy Ave E, Saint Paul, MN 55101 | 2014-09-30 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55130 |
Please comment or provide details below to improve the information on JEFFREY CHARLES OTIS.
| 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.