Jacqueline S Otamiri, LSA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

SA00870 Issued in TX

Practice address

9355 John W Elliott Dr Ste 25461
Frisco, TX 75033-3665

Phone

(214) 227-2457

Fax

(214) 764-0880

NPI assigned

Apr 12, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Jacqueline S McCorkle Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Surgery Pro LLC

  • Surgical Assistant
  • Frisco, TX
  • NPI 1750972063
  NPD Authorized official
• The Surgery Pro

  • Surgical Assistant
  • Frisco, TX
  • NPI 1639787385
  NPD Authorized official

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

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1396188041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2550",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750302550",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9355 JOHN W ELLIOTT DR STE 25461",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750333665",
            "telephone_number": "214-227-2457",
            "fax_number": "214-764-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTAMIRI",
        "first_name": "JACQUELINE",
        "middle_name": "S",
        "credential": "LSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-12",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "186634",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "SA00870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "MCCORKLE",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gregory Frank Osier, PA-C
• Josephine Osifo
• Lynnald Osovoyoron
• Osullivan Ventures Corporation (Home Helpers Home Care of Frisco, TX)
• Mark F Osunero-Lanuza, LMT, MMP, CNMT, CES
• Leila Othman, RBT
• Huiyan Ouyang, MT
• Natalia Ovcharenko, D.D.S., MSD
• Kfir Oved, M.D.
• Angela Overby, LVN

• Surgical Assistant in Frisco, TX
• Providers in Frisco, TX by specialty
• Surgical Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.