Provider Demographics
NPI:1497725188
Name:KIMMEL, JOCELYN RAE (PA C)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:RAE
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:
Other - Last Name:AUKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1001 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1003
Mailing Address - Country:US
Mailing Address - Phone:330-744-2118
Mailing Address - Fax:330-744-2110
Practice Address - Street 1:1001 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1003
Practice Address - Country:US
Practice Address - Phone:330-744-2118
Practice Address - Fax:330-744-2110
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
50002111363AM0700X
OH50.002111RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082587Medicaid
OH0082587Medicaid