Healthcare Provider Details

I. General information

NPI: 1316226384
Provider Name (Legal Business Name): JAN MICHELLE DARTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN MICHELLE KEHRES PA

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4008
US

IV. Provider business mailing address

6470 TIPPECANOE RD
CANFIELD OH
44406-7036
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-0577
  • Fax: 330-533-4587
Mailing address:
  • Phone: 330-758-0577
  • Fax: 330-758-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberMA055065
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA055065
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.003658
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.003658
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: