Provider Demographics
NPI:1447686944
Name:DOSSOU, STARLETTE JESSICA YEHINOU (PA-C)
Entity type:Individual
Prefix:
First Name:STARLETTE
Middle Name:JESSICA YEHINOU
Last Name:DOSSOU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STARLETTE
Other - Middle Name:JACKSON YEHINOU
Other - Last Name:DOSSOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 RIDGE ST STE 307
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4643
Mailing Address - Country:US
Mailing Address - Phone:712-329-5700
Mailing Address - Fax:712-329-5759
Practice Address - Street 1:800 MERCY DR # 210
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-3128
Practice Address - Country:US
Practice Address - Phone:712-329-5700
Practice Address - Fax:712-329-5759
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1764363A00000X
IA002443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant