Provider Demographics
NPI:1427003177
Name:WEDEL, JAY L (PAC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:WEDEL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:705 E RANDALL
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062
Mailing Address - Country:US
Mailing Address - Phone:620-327-2440
Mailing Address - Fax:620-327-2062
Practice Address - Street 1:705 E RANDALL
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062
Practice Address - Country:US
Practice Address - Phone:620-327-2440
Practice Address - Fax:620-327-2062
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042826Medicare ID - Type Unspecified