Healthcare Provider Details

I. General information

NPI: 1194151654
Provider Name (Legal Business Name): JESSICA LAUREN KLAUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 WHIPPLE AVE NW
NORTH CANTON OH
44720-7618
US

IV. Provider business mailing address

1401 S ARCH AVE STE A
ALLIANCE OH
44601-4288
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-6999
  • Fax: 330-244-8115
Mailing address:
  • Phone: 330-596-7581
  • Fax: 844-269-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003852
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50,003852
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: