Provider Demographics
NPI:1417566233
Name:DOUANGPRASEUTH, JASMINE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ANN
Last Name:DOUANGPRASEUTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2412
Mailing Address - Country:US
Mailing Address - Phone:620-500-5998
Mailing Address - Fax:
Practice Address - Street 1:421 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2412
Practice Address - Country:US
Practice Address - Phone:620-500-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78766-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily