Provider Demographics
NPI:1275224461
Name:HERL, JARED KENNETH
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:KENNETH
Last Name:HERL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34097 N RD
Mailing Address - Street 2:
Mailing Address - City:OGALLAH
Mailing Address - State:KS
Mailing Address - Zip Code:67656-9650
Mailing Address - Country:US
Mailing Address - Phone:785-726-1016
Mailing Address - Fax:
Practice Address - Street 1:34097 N RD
Practice Address - Street 2:
Practice Address - City:OGALLAH
Practice Address - State:KS
Practice Address - Zip Code:67656-9650
Practice Address - Country:US
Practice Address - Phone:785-726-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty