Provider Demographics
NPI:1346554920
Name:KEARNS, JASON EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:KEARNS
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 1:1202 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1070
Mailing Address - Country:US
Mailing Address - Phone:620-778-0953
Mailing Address - Fax:
Practice Address - Street 1:949 E TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5728
Practice Address - Country:US
Practice Address - Phone:918-224-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4521363A00000X
KS15-01411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant