Jennifer L. Spady, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3692-023 Issued in WI

Practice address

1310 Broadway
Wisconsin Dells, WI 53965-1358

Phone

(608) 253-1171

Fax

(608) 253-8012

NPI assigned

Jul 24, 2015

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

• Jennifer L. Biestek Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 25, 2016.

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1528443108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 BROADWAY",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "539651358",
            "telephone_number": "608-253-1171",
            "fax_number": "608-253-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 BROADWAY",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "539651358",
            "telephone_number": "608-253-1171",
            "fax_number": "608-253-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPADY",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-24",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3692-023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528443108",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BIESTEK",
            "middle_name": "L.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tammy M Rockweiler, APNP
• Gregory Richard Rowe
• Mary Ellen Sabourin, MD
• School District of Wisconsin Dells
• Erik R Snortum, PT
• Lori J Spencer, APNP
• SSM Health Care of Wisconsin Inc
• Jennifer L Stremcha, R.D.
• Jeffrey Sveum
• Patrick F Sweeney, DDS

• All providers in Wisconsin Dells, WI
• Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; 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.