Jessica G Luckenbill, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.003591 Issued in OH

Practice address

9000 N Main St
Suite 200
Englewood, OH 45415-1180

Phone

(937) 836-5555

Fax

(937) 836-7518

NPI assigned

Sep 18, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436572800000",
    "number": "1174873103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST",
            "address_2": "SUITE 200",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "454151180",
            "telephone_number": "937-836-5555",
            "fax_number": "937-836-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 N MAIN ST",
            "address_2": "SUITE 200",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "454151180",
            "telephone_number": "937-836-5555",
            "fax_number": "937-836-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCKENBILL",
        "first_name": "JESSICA",
        "middle_name": "G",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-18",
        "last_updated": "2015-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0074453",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Long Prentice, MD
• Alexander Benjamin Long, MD
• Wanda Long
• Diana Lowe
• Marissa Lown, DO
• Kimberly Nicole Luna, DDS
• Kendra S Magnuson
• Rosalie Makridis, MA, LSW
• Angelique Malone
• Leigh Anne Malott, PTA

• Physician Assistant in Englewood, OH
• Providers in Englewood, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.