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Jessica A Roadt

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

2901 W Kinnickinnic River Pkwy Ste 310, Milwaukee, WI 53215-3660

PECOS Enrollment

Based on the most recent information from CMS, provider Jessica A Roadt does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:26 AM.

Profile Details

Provider ID
1295118487
Provider Type
Individual
Full Name
Roadt, Jessica A
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
7/7/2015
Last Updated
7/21/2022

Contact Information

Practice Location

2901 W Kinnickinnic River Pkwy Ste 310, Milwaukee, WI 53215-3660

(414) 649-3990

Unlisted Fax

Mailing Location

2901 W Kinnickinnic River Pkwy Ste 310, Milwaukee, WI 53215-3660

(414) 649-3990

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 354423 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID K400397443	Description Other	Issuer MEDICARE PTAN Wisconsin
ID 1295118487	Description Medicaid	Issuer Unlisted Wisconsin

Jessica A Roadt

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Cook, Haley C

Reagan, Constance Louise

Zimmet, Kristin L.

Fehrenbacher, Timothy Allen

Brigden, Elizabeth A.

Mccandless, Cassidy Sarah

Kamelle, Christine B

Pruessing, Paul

Glodowski, Kelly M

Mcwherter, Mattison Marie