Provider Demographics
NPI:1437589504
Name:COLICA-EKNESS, JAIMIE ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:ANN
Last Name:COLICA-EKNESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAIMIE
Other - Middle Name:ANN
Other - Last Name:COLICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:150 INFIRMARY WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9288
Mailing Address - Country:US
Mailing Address - Phone:413-577-5000
Mailing Address - Fax:413-577-5440
Practice Address - Street 1:150 INFIRMARY WAY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9288
Practice Address - Country:US
Practice Address - Phone:413-577-5000
Practice Address - Fax:413-577-5440
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NC0010-10729363A00000X
MAPA7886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MC6794184OtherDEA