Provider Demographics
NPI:1619125697
Name:SMEADER, JESSICA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:SMEADER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-302
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7070
Mailing Address - Fax:269-341-7244
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M302
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7070
Practice Address - Fax:269-341-7244
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
MI5601005371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C97618OtherBCBSM
MI1619125697Medicaid
MI1619125697Medicaid