Jessica Dawn Hagen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2478-023 Issued in WI

Practice address

5330 W. Villard Avenue
Milwaukee, WI 53218

Phone

(414) 463-9159

Fax

(414) 831-0422

NPI assigned

Aug 4, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jessica Dawn Watkins Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348185600000",
    "number": "1194956417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5330 W. VILLARD AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53218",
            "telephone_number": "414-463-9159",
            "fax_number": "414-831-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 W. VILLARD AVENUE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53218",
            "telephone_number": "414-463-9159",
            "fax_number": "414-831-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "JESSICA",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-04",
        "last_updated": "2012-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "2478-023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "WATKINS",
            "middle_name": "DAWN",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Victoria Hagan, LPC-IT
• Ke'Andra L Hagans, MSW, LCSW
• Lori Hagar, NP
• Darcey A Hagemann, PA
• Alexandria Mia Hagen, CF-SLP
• Lauren Hagenstein
• Michael Hagerty, M.A. SLP
• Leila Haghi, MD
• Kristin Anne Haglund, PHD, APRN
• Danita Rose Hahn, MD

• Medical Physician Assistant in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.