Provider Demographics
NPI:1548462286
Name:PANTON, JAIME (CPNP-AC/PC)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:PANTON
Suffix:
Gender:F
Credentials:CPNP-AC/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4103
Mailing Address - Country:US
Mailing Address - Phone:212-326-5705
Mailing Address - Fax:
Practice Address - Street 1:516 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4103
Practice Address - Country:US
Practice Address - Phone:212-326-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382878363LP0200X
LAAP05231363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1014435Medicaid