Provider Demographics
NPI:1326396565
Name:AGAN, JAMIE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:AGAN
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 74008272
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8272
Mailing Address - Country:US
Mailing Address - Phone:702-899-0595
Mailing Address - Fax:702-977-1496
Practice Address - Street 1:6550 E 45TH ST N
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-8813
Practice Address - Country:US
Practice Address - Phone:872-231-3162
Practice Address - Fax:702-977-1496
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2025-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01550363A00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS132639656Medicaid
KS132639656Medicaid