1609069566 NPI number — JACQUELINE J JAMES PA-C

Table of content: JACQUELINE J JAMES PA-C (NPI 1609069566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609069566 NPI number — JACQUELINE J JAMES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMES
Provider First Name:
JACQUELINE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINNELL
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609069566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 OLD CENTRE ROAD
Provider Second Line Business Mailing Address:
SOUTHWEST MICHIGAN DERMATOLOGY, A DIVISION OF PARAGON H
Provider Business Mailing Address City Name:
PORTAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-321-7546
Provider Business Mailing Address Fax Number:
269-321-1705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3480 CAPITAL AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-9354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-224-6554
Provider Business Practice Location Address Fax Number:
269-224-6537
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 5601005156 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609069566 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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