Provider Demographics
NPI:1235838228
Name:TIMMERMANN, DYLAN G (PA-C)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:G
Last Name:TIMMERMANN
Suffix:
Gender:M
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 1:5120 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2321
Mailing Address - Country:US
Mailing Address - Phone:785-408-5800
Mailing Address - Fax:785-730-8700
Practice Address - Street 1:5120 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2321
Practice Address - Country:US
Practice Address - Phone:785-408-5800
Practice Address - Fax:785-730-8700
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023009268363A00000X
KS15-02754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant