Provider Demographics
NPI:1639705536
Name:PLEASANTS, JOHN B (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:PLEASANTS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:PLEASANTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:46 BARRA RD
Mailing Address - Street 2:STE 201-202
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-3349
Mailing Address - Fax:
Practice Address - Street 1:46 BARRA RD STE 201-202
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9459
Practice Address - Country:US
Practice Address - Phone:207-282-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2085363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1639705536Medicaid