Provider Demographics
NPI:1295815330
Name:KRUSE, JASON (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KRUSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 N ROCK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1264
Mailing Address - Country:US
Mailing Address - Phone:316-612-1833
Mailing Address - Fax:316-612-2420
Practice Address - Street 1:828 ELMHURST BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7406
Practice Address - Country:US
Practice Address - Phone:785-827-2500
Practice Address - Fax:785-827-2515
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS40040050AMedicaid
KS40040050AMedicaid
KSP05605Medicare UPIN