Provider Demographics
NPI:1316226384
Name:DARTT, JAN MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:MICHELLE
Last Name:DARTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:MICHELLE
Other - Last Name:KEHRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6470 TIPPECANOE RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7036
Mailing Address - Country:US
Mailing Address - Phone:330-758-0577
Mailing Address - Fax:330-758-0466
Practice Address - Street 1:1499 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4008
Practice Address - Country:US
Practice Address - Phone:330-758-0577
Practice Address - Fax:330-533-4587
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055065363AS0400X, 363AM0700X
OH50.003658363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical