Provider Demographics
NPI:1184733743
Name:MARTIN, JOLENA M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOLENA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JOLENA
Other - Middle Name:M
Other - Last Name:KING, SOSAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0930
Mailing Address - Country:US
Mailing Address - Phone:217-474-5658
Mailing Address - Fax:307-225-2095
Practice Address - Street 1:116 W BRIDGE AVE
Practice Address - Street 2:WEST SUITE
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331
Practice Address - Country:US
Practice Address - Phone:307-329-3340
Practice Address - Fax:307-225-2095
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA860363A00000X
TXPA15326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
385364383OtherTRICARE PROVIDER NUMBER
P00382765OtherRAILROAD MEDICARE
Q58991Medicare UPIN
IL0407950001Medicare NSC
ILK37438Medicare PIN