Provider Demographics
NPI:1972881464
Name:HASSKAMP, JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:HASSKAMP
Suffix:
Gender:F
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 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3514 21ST ST FL 6
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-725-2263
Practice Address - Fax:806-723-7768
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207773100OtherFIRSTCARE
NM000E6064Medicaid
TXP01059324OtherRAILROAD MEDICARE
TXTXB139806OtherMEDICARE
TX899N88OtherBCBS
TX286620401Medicaid