Provider Demographics
NPI:1548743636
Name:JABLONSKI, ELYSE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:ANN
Last Name:JABLONSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:ANN
Other - Last Name:BIGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1684 S LOGAN PASS
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7914
Mailing Address - Country:US
Mailing Address - Phone:316-587-5334
Mailing Address - Fax:620-629-6684
Practice Address - Street 1:315 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-629-6477
Practice Address - Fax:620-629-6651
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1502133363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical