Healthcare Provider Details

I. General information

NPI: 1952655128
Provider Name (Legal Business Name): COURTNEY RAE JORRIS M.S., PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

IV. Provider business mailing address

850 COLUMBIA RD STE 200
WESTLAKE OH
44145-7215
US

V. Phone/Fax

Practice location:
  • Phone: 440-808-1212
  • Fax:
Mailing address:
  • Phone: 440-808-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.004405RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.004405RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: