Provider Demographics
NPI:1881009579
Name:JAECKLE, STEVEN ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:JAECKLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 N IH 35 STE 2600
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-4337
Mailing Address - Country:US
Mailing Address - Phone:512-465-4800
Mailing Address - Fax:512-420-0118
Practice Address - Street 1:6406 N IH 35 STE 2600
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-4337
Practice Address - Country:US
Practice Address - Phone:512-465-4800
Practice Address - Fax:512-420-0118
Is Sole Proprietor?:No
Enumeration Date:2014-06-22
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017575363A00000X
NVPA1734363A00000X
TXPA14927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1881009579Medicaid
NVV50249Medicare PIN