Provider Demographics
NPI:1740766658
Name:BASSETT, JACLYN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:BASSETT
Suffix:
Gender:F
Credentials: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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-226-0112
Mailing Address - Fax:515-223-0422
Practice Address - Street 1:1525 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3442
Practice Address - Country:US
Practice Address - Phone:515-226-0112
Practice Address - Fax:515-223-0422
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363A00000X
COPA.0005433363AM0700X
IA125134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical