Provider Demographics
NPI:1174301998
Name:AUSTIN, JAYDEN (PA-C)
Entity type:Individual
Prefix:
First Name:JAYDEN
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-4206
Mailing Address - Country:US
Mailing Address - Phone:316-200-7181
Mailing Address - Fax:
Practice Address - Street 1:900 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-4206
Practice Address - Country:US
Practice Address - Phone:316-200-7181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant