Provider Demographics
NPI:1659324663
Name:JAEGER, DUANE C (ARNP, BC)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:C
Last Name:JAEGER
Suffix:
Gender:M
Credentials:ARNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 SHADY WAY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3416
Mailing Address - Country:US
Mailing Address - Phone:316-651-3621
Mailing Address - Fax:316-681-5570
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-651-3621
Practice Address - Fax:316-681-5570
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74618364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS74618OtherPSYCHIATRIC CERTIFICATION
KS14-052505-012OtherRN LICENSE