Provider Demographics
NPI:1396230645
Name:DOBSON, JILLIAN MARI (MSPAS, PA-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MARI
Last Name:DOBSON
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEDICAL PARK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-4800
Mailing Address - Fax:304-242-3580
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:SUITE 104
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-4800
Practice Address - Fax:304-242-3580
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WV2193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0333130Medicaid