JERROLD PAUL ELLIOTT III (NPI# 1982854618) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982854618 |
| Entity Type | Individual |
| Full Name | JERROLD PAUL ELLIOTT III |
| Credential | PA-C |
| Practice Address |
16319 Third Street Guerneville CA 95446 |
| Mailing Address |
Po Box 1449 Guerneville CA 95446-1449 |
| Practice Telephone | 7078695977 |
| Practice Fax Number | 7078695983 |
| Mailing Telephone | 7078695977 |
| Mailing Fax Number | 7078695983 |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2015-07-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 2666 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA20527 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 1356344758 | 05 |
| Street Address |
16319 THIRD STREET |
| City | GUERNEVILLE |
| State | CA |
| Zip Code | 95446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356344758 | West County Health Centers, Inc. | Clinic/Center | 16319 Third Street, Guerneville, CA 95446 | 2005-05-31 |
| 1962728550 | Jared Nikolaus Garrison-jakel | Family Medicine | 16319 Third Street, Guerneville, CA 95446 | 2010-04-08 |
| 1548415508 | Jude Fox | Physician Assistant | 16319 Third Street, Guerneville, CA 95446 | 2008-11-18 |
| 1558528349 | Deette Deville | Family Medicine | 16319 Third Street, Guerneville, CA 95446 | 2008-05-20 |
| 1124226931 | Susan Maria Lavelle | Nurse Practitioner | 16319 Third Street, Guerneville, CA 95446 | 2007-07-03 |
| 1265449797 | Mary Wyman | Nurse Practitioner | 16319 Third Street, Guerneville, CA 95446 | 2006-08-01 |
| 1134135924 | Surani Hayre-kwan | Nurse Practitioner | 16319 Third Street, Guerneville, CA 95446 | 2006-07-31 |
| 1528072386 | West County Health Centers, Inc | Clinic/Center | 16319 Third Street, Guerneville, CA 95446-1449 | 2006-07-28 |
| 1689671968 | Steven Bromer | Family Medicine | 16319 Third Street, Guerneville, CA 95446 | 2005-07-01 |
| 1114923745 | Susan Skolek | Psychologist | 16319 Third Street, Guerneville, CA 95446 | 2005-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659840387 | Thomas N Tiffer | Taxi | 14701 Canyon 7 Rd, Guerneville, CA 95446 | 2018-11-26 |
| 1265969059 | Teresa Bowden | Counselor | 16255 1st Street, Guerneville, CA 95446 | 2017-05-11 |
| 1255882502 | Skye Ashley | Marriage & Family Therapist | 16390 Main Street, Guerneville, CA 95446 | 2016-10-21 |
| 1326461187 | Christopher Arthur Newell | Pharmacist | 16251 Main St., Lark Drugs, Guerneville, CA 95446 | 2014-01-30 |
| 1750658159 | Daryl Wolfe | Pharmacist | 16405 River Rd, Guerneville, CA 95446 | 2011-11-30 |
| 1881995041 | Declan Gerard Prendergast | Pharmacist | 16405 River Rd., Guerneville, CA 95446 | 2010-11-04 |
| 1154523272 | West County Community Services | Community/Behavioral Health | 14520 Armstrong Woods Rd, Guerneville, CA 95446 | 2007-06-01 |
| 1912128661 | Raymond Francis Skryja | Dentist | 14001 Old Cazadero Rd, Guerneville, CA 95446 | 2007-05-01 |
| 1598786352 | West County Health Centers, Inc. | Clinic/Center | 16312 Third Street, Guerneville, CA 95446 | 2006-07-21 |
| 1255365532 | Suzanne Kay Saville | Dentist | 16312 3rd Street, Guerneville, CA 95446 | 2006-07-10 |
| Find all providers in zip 95446 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093231920 | Aimee Laurenne Greenfield | Physician Assistant | 14045 Mill St, Guerneville, CA 95446-8303 | 2017-08-22 |
| 1548415508 | Jude Fox | Physician Assistant | 16319 Third Street, Guerneville, CA 95446 | 2008-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760089437 | Karine Harutyunyan | Physician Assistant | 500 E Colorado St Ste 101, Glendale, CA 91205-1607 | 2020-10-06 |
| 1437756228 | Kale Burket | Physician Assistant | Bldg 523, S 8th St, El Centro, CA 92243 | 2020-10-05 |
| 1548867666 | Heba Marzouk Al-shoubaki | Physician Assistant | 633 S Pepper St, Anaheim, CA 92802-1459 | 2020-10-01 |
| 1275140550 | Lisa Lynn Passalacqua | Physician Assistant | 431 7th St, Norco, CA 92860-1671 | 2020-09-30 |
| 1144833989 | Trisha Taylor | Physician Assistant | 10399 Tivoli Way, Yucaipa, CA 92399-6017 | 2020-08-30 |
| 1457963944 | Harlan William Monahan | Physician Assistant | 5210 Del Rio Rd, Sacramento, CA 95822-2519 | 2020-08-18 |
| 1275144313 | Sofia Carmen Bustillo | Physician Assistant | 1709 Coral Pl, Seal Beach, CA 90740-5712 | 2020-08-12 |
| 1124638663 | Gayaneh Gharakhani | Physician Assistant | 1323 E Broadway Apt 110, Glendale, CA 91205-4018 | 2020-08-07 |
| 1144830183 | Loc Bao Tran | Physician Assistant | 8937 Emerson Pl, Rosemead, CA 91770-2813 | 2020-08-04 |
| 1558997957 | Sarah Lubinsky | Physician Assistant | 1511 Montana Ave, Santa Monica, CA 90403-1891 | 2020-03-17 |
| Find all providers with the same taxonomy | ||||
| City | GUERNEVILLE |
| Zip Code | 95446 |
Please comment or provide details below to improve the information on JERROLD PAUL ELLIOTT III.
| 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.