Healthcare Provider Details

I. General information

NPI: 1043510050
Provider Name (Legal Business Name): JESSICA N STALEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 INDEPENDENCE AVE
AKRON OH
44310-1812
US

IV. Provider business mailing address

1260 INDEPENDENCE AVE
AKRON OH
44310-1812
US

V. Phone/Fax

Practice location:
  • Phone: 234-312-2111
  • Fax: 330-634-9558
Mailing address:
  • Phone: 234-312-2111
  • Fax: 330-634-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003178
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: