Provider Demographics
NPI:1457752537
Name:JANKORD, CASEY B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:B
Last Name:JANKORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CASEY
Other - Middle Name:B
Other - Last Name:JANKORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 ANDERSON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-7603
Mailing Address - Country:US
Mailing Address - Phone:785-539-4645
Mailing Address - Fax:785-539-1655
Practice Address - Street 1:4201 ANDERSON AVE STE F
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7603
Practice Address - Country:US
Practice Address - Phone:785-539-4645
Practice Address - Fax:785-539-1655
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant