Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jaclyn Green

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1114650413

Jaclyn Green is a Physician Assistant in Milwaukee, Wisconsin. Qualified in 2024, 2 years ago. Practices with Emergency Medicine Specialists SC, a 220-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
2
Licensed in
WI
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

1312 E Oklahoma Ave
Milwaukee, WI 53207-2457
Phone: (414) 595-4570
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7895-23 (WI)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1114650413
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 5, 2022
Last updated in NPPESJuly 4, 2024
Certification dateJuly 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Emergency Medicine Specialists Sc — 220 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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