Provider Demographics
NPI:1992844450
Name:KINDLE, JASON (PT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:KINDLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65350-1038
Mailing Address - Country:US
Mailing Address - Phone:660-343-5316
Mailing Address - Fax:660-343-5389
Practice Address - Street 1:505 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:MO
Practice Address - Zip Code:65350-1038
Practice Address - Country:US
Practice Address - Phone:660-343-5316
Practice Address - Fax:660-343-5389
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105632174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist