Provider Demographics
NPI:1609384437
Name:TAMELER, JESSICA L (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:TAMELER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632111
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2111
Mailing Address - Country:US
Mailing Address - Phone:812-450-6879
Mailing Address - Fax:812-858-4586
Practice Address - Street 1:350 W COLUMBIA ST STE 310
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-464-9133
Practice Address - Fax:812-464-0559
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC688363A00000X
KYPA2335363A00000X
NC001008943363AS0400X
IN10003299A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100505430Medicaid