Provider Demographics
NPI:1467622852
Name:CHRISTIANSEN, JARED (PA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 W FARM WAY
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-3713
Mailing Address - Country:US
Mailing Address - Phone:503-949-4086
Mailing Address - Fax:
Practice Address - Street 1:7600 BEECHNUT ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4389
Practice Address - Country:US
Practice Address - Phone:713-456-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA05496OtherTX. LICENSE