Provider Demographics
NPI:1962753830
Name:HART, JEANNETTE STUART (PA-C)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:STUART
Last Name:HART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:STUART
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1305 FOWLER ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4719
Mailing Address - Country:US
Mailing Address - Phone:509-940-2284
Mailing Address - Fax:509-940-2286
Practice Address - Street 1:1305 FOWLER ST STE 1D
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4719
Practice Address - Country:US
Practice Address - Phone:509-940-2284
Practice Address - Fax:509-940-2286
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60316098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant