Healthcare Provider Details

I. General information

NPI: 1548498652
Provider Name (Legal Business Name): JESSICA LYNN SWARR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/13/2022
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ ADVANCE PRACTICE ENT
DAYTON OH
45404-1873
US

IV. Provider business mailing address

4221 MALSBARY RD STE 102
BLUE ASH OH
45242-5521
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-4647
  • Fax: 937-641-4617
Mailing address:
  • Phone: 513-241-1811
  • Fax: 513-241-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004775RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054325
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: