Provider Demographics
NPI:1194151654
Name:KLAUS, JESSICA LAUREN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAUREN
Last Name:KLAUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 S ARCH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4288
Mailing Address - Country:US
Mailing Address - Phone:330-596-7581
Mailing Address - Fax:844-269-4253
Practice Address - Street 1:6100 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7618
Practice Address - Country:US
Practice Address - Phone:330-305-6999
Practice Address - Fax:330-244-8115
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003852363AM0700X
OH50,003852363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093760Medicaid