Healthcare Provider Details

I. General information

NPI: 1710562111
Provider Name (Legal Business Name): JESSICA LYNN BARAT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LYNN BRASHEAR PA-C

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7645 MARKET ST STE 210
BOARDMAN OH
44512-6098
US

IV. Provider business mailing address

1221 BARKER BLVD APT A
KENT OH
44240-8623
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-3724
  • Fax:
Mailing address:
  • Phone: 724-496-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007169RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: