Provider Demographics
NPI:1922047042
Name:PARSONS, MARIA JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JESSICA
Last Name:PARSONS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:JESSICA
Other - Last Name:HYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1867
Practice Address - Country:US
Practice Address - Phone:231-672-8643
Practice Address - Fax:231-672-8651
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004595363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN94150010OtherMEDICARE PTAN
MIQ65215Medicare UPIN