Carol L Jeglum, PAC – Physician Assistant

Key facts

NPI: 1427021971
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 1650 (IA)
Practice address: 112 Jefferson St
West Union, IA 52175-1022
Phone: (563) 422-3811
Fax: (563) 422-9520
NPI assigned: Feb 7, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Mayo Clinic Health System-Southwest Wisconsin Region, Inc. Multi-Specialty Clinic/Center · La Crosse, WI · NPI 1629056049

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
1650	IA	MD	Physician Assistant

Practice roles

Organization	Specialty	Status	New patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc.		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	1650	IA	Yes

Addresses

Primary practice location

112 Jefferson St
West Union, IA 52175-1022

Mailing address

1836 South Ave
Credentialing
La Crosse, WI 54601-5429
Phone (800) 362-9567

Other providers in West Union, IA

All providers in West Union, IA · Physician Assistant in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.