JENELLE SILLS FLEMING (NPI# 1700386711) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700386711 |
| Entity Type | Individual |
| Full Name | JENELLE SILLS FLEMING |
| Practice Address |
11315 Pembrooke Sq Ste 111 Waldorf MD 20603-4806 |
| Mailing Address |
2602 Brinkley Rd Apt 910 Fort Washington MD 20744-1930 |
| Practice Telephone | 2402522150 |
| Mailing Telephone | 5408188211 |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-12-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | C0006949 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 0110006078 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9001 Digges Rd Ste 107, Manassas, VA 201104414 | 7033301112 |
| Street Address |
11315 PEMBROOKE SQ STE 111 |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-4806 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831417476 | Civista Clinical Services LLC | Clinic/Center | 11315 Pembrooke Sq Ste 111, Waldorf, MD 20603-4806 | 2010-05-06 |
| 1952814204 | Shawnee Lakai Thomas | Registered Nurse | 11315 Pembrooke Sq Ste 111, Waldorf, MD 20603 | 2017-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| Find all providers in zip 20603 | ||||
| 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 |
|---|---|---|---|---|
| 1629553383 | Deasia Henderson | Physician Assistant | 3460 Old Washington Rd Ste 300, Waldorf, MD 20602-3245 | 2018-09-28 |
| 1215448360 | Joanna Goyette Smith | Physician Assistant | 102 Paul Mellon Ct Ste 102, Waldorf, MD 20602-2793 | 2017-10-17 |
| 1346642311 | Heather Leigh Pridgen Powell | Physician Assistant | 11637 Terrace Dr Ste 100, Waldorf, MD 20602-3707 | 2014-09-22 |
| 1619386471 | Sabena Juzer Modi-masood | Physician Assistant | 102 Paul Mellon Ct Suite 102, Waldorf, MD 20602-2788 | 2014-08-06 |
| 1255676086 | Abeba A. Tadesse | Physician Assistant | 12070 Old Line Center, Suite 210, Waldorf, MD 20602-2567 | 2012-12-05 |
| 1356614655 | Bemnet Zeleke Zeleke | Physician Assistant | 7 Post Office Rd # 7c, Waldorf, MD 20602-2744 | 2012-02-16 |
| 1023385457 | Kristen Elise Lohr | Physician Assistant | 12090 Old Line Centre, Waldorf, MD 20602 | 2011-11-30 |
| 1407059967 | Carla D. Hines | Physician Assistant | 12070 Old Line Center Drive, Suite 210, Waldorf, MD 20602 | 2007-06-11 |
| 1629079454 | S Michelle Thornblade | Physician Assistant | 3975 Saint Charles Pkwy, Waldorf, MD 20602-2683 | 2005-08-02 |
| 1568917383 | Heart Center of Southern Maryland | Physician Assistant | 3510 Old Washington Rd, Suite 100, Waldorf, MD 20602-3233 | 2016-08-22 |
| Find all providers in WALDORF | ||||
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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.