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General NPI Number Information
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NPI Number | 1770868697
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Entity Type | Individual
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Provider Name | JESSICA LYNNE STAGER PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 5735 MEEKER RD
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City | GREENVILLE
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State | OH
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Zip | 45331-1186
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Country | US
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Telephone | 937-548-9680
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Fax | 937-548-2087
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Provider Business Mailing Address
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Address Line | 5735 MEEKER RD
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City | GREENVILLE
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State | OH
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Zip | 45331-1186
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Country | US
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Telephone | 937-548-3806
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Fax | 937-548-2087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50003341
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.003341
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License Number State | OH
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