Jacqueline Edwards

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

58432 Issued in CA

Practice address

57402 Twentynine Palms Highway #1
Suite 1
Yucca Valley, CA 92284-9228

Phone

(760) 365-2520

Fax

(484) 526-6546

NPI assigned

Oct 10, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA, CA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mint Health Solutions, Inc

  • Internal Medicine Physician
  • Pasadena, CA
  • NPI 1316543119
  Medicare reassignment
• St. Luke'S Physician Group, Inc.

  • Family Medicine Physician
  • Bethlehem, PA
  • NPI 1700984622
  Medicare reassignment
• St Luke'S Physician Group Inc

  • Family Medicine Physician
  • Orwigsburg, PA
  • NPI 1710845144
  NPD
• St. Luke'S Physician Group, Inc.

  • Pediatric Allergy/Immunology Physician
  • Bethlehem, PA
  • NPI 1063003598
  NPD

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1295285773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3071",
            "city": "LANDERS",
            "state": "CA",
            "postal_code": "922850071",
            "telephone_number": "484-347-3939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57402 TWENTYNINE PALMS HIGHWAY #1",
            "address_2": "SUITE 1",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922849228",
            "telephone_number": "760-365-2520",
            "fax_number": "484-526-6546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JACQUELINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-10",
        "last_updated": "2021-11-12",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA058708",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelique Eddins
• Sherri Lynn Edelstein
• Amy Eden
• Edith a. Jones-Poland MD Professional Corp
• Clint Edwards
• Effel LLC Dba Effel Medical Respite
• Eisenhower Medical Center
• Eliott Romero, MD Corp
• Ellee Residential Care #3
• Heather A Ellens

• Physician Assistant in Yucca Valley, CA
• Providers in Yucca Valley, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; 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.