Active NPI
Jaclyn S Presley, PA
- Physician Assistant
- Vernon, NY
National Provider Identifier
1811176183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 012218
- Practice address
- 4857 State Route 5
Vernon, NY 13476 - Phone
- (315) 363-9995
- Fax
- (315) 363-9686
- NPI assigned
- Nov 2, 2007
- Last updated
- Feb 15, 2016
- 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 | 012218 | NY | Primary |
Addresses
Primary practice location
4857 State Route 5
Vernon, NY 13476
Mailing address
4857 State Route 5
Vernon, NY 13476
Phone (315) 363-9995
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02948763 | Medicaid | NY |
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 |
|---|---|---|---|
| 012218 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455494400000",
"number": "1811176183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4857 STATE ROUTE 5",
"city": "VERNON",
"state": "NY",
"postal_code": "13476",
"telephone_number": "315-363-9995",
"fax_number": "315-363-9686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4857 STATE ROUTE 5",
"city": "VERNON",
"state": "NY",
"postal_code": "13476",
"telephone_number": "315-363-9995",
"fax_number": "315-363-9686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRESLEY",
"first_name": "JACLYN",
"middle_name": "S",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-02",
"last_updated": "2016-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "012218",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02948763",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vernon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.