Active NPI
Jessica Osei Yeboah, PAC
- Physician Assistant
- Watervliet, MI
National Provider Identifier
1427077452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601004473
- Practice address
- 400 Medical Park Dr
Watervliet, MI 49098-9225 - Phone
- (269) 463-3600
- Fax
- (269) 463-8206
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601004473 | MI | Primary |
Addresses
Primary practice location
400 Medical Park Dr
Watervliet, MI 49098-9225
Mailing address
400 Medical Park Drive
Watervliet, MI 49098
Phone (269) 463-3600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427077452 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601004473 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1427077452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 MEDICAL PARK DRIVE",
"city": "WATERVLIET",
"state": "MI",
"postal_code": "49098",
"telephone_number": "269-463-3600",
"fax_number": "269-463-8206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 MEDICAL PARK DR",
"city": "WATERVLIET",
"state": "MI",
"postal_code": "490989225",
"telephone_number": "269-463-3600",
"fax_number": "269-463-8206"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSEI YEBOAH",
"first_name": "JESSICA",
"name_prefix": "Miss",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601004473",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1427077452",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watervliet, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.