Jessica Jiyoung An, CRNP
Individual provider Active NPI Family Medicine Physician · Elkton, MD
NPI 1790325546 · NPPES record last updated Jan 9, 2020
Key facts
- NPI
- 1790325546
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- R222999 (MD)
- Practice address
- 111 W High St Ste 314
Elkton, MD 21921-8617 - Phone
- (410) 620-0545
- NPI assigned
- Jan 9, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200224000050 | MD | Practitioner - Nurse Practitioner | 5496182990 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R222999 | MD | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Union Hospital of Cecil County | Current |
Accepting new patients | |
| Union Hospital of Cecil County | Family Medicine | Current |
Accepting new patients |
Locations
106 Bow St
Elkton, MD 21921
Phone (410) 298-2000
111 W High St
Ste 314
Elkton, MD 21921
Phone (410) 398-4510
106 Bow St
Ofc
Elkton, MD 21921
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R222999 | MD | Yes |
Addresses
Primary practice location
111 W High St Ste 314
Elkton, MD 21921-8617
Mailing address
106 Bow St
Elkton, MD 21921-5596
Other providers in Elkton, MD
- Always There Adult Day Services
- Renee M Amburn
- Amedisys Hospice, L.L.C.
- Amna Medical Center
- Amna Medical Center, LLC
- Bria Anderson
- John Howard Anderson
- Tracy Anderson
- Christina Grace Andrews
- Angela Coleman NP LLC
All providers in Elkton, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.