Provider Demographics
NPI:1841381522
Name:TWOMBLY, JODI M (PA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:TWOMBLY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 UTAH, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2314
Mailing Address - Country:US
Mailing Address - Phone:785-742-2161
Mailing Address - Fax:785-742-7602
Practice Address - Street 1:300 UTAH, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2314
Practice Address - Country:US
Practice Address - Phone:785-742-2161
Practice Address - Fax:785-742-7602
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100419020CMedicaid
042844OtherBLUE CROSS BLUE SHIELD KS
KS100419020BMedicaid
428060OtherFIRSTGUARD HEALTH PLAN
KS100419020AMedicaid
KS100419020AMedicaid
KS100419020BMedicaid
KS068002010Medicare PIN