Provider Demographics
NPI:1780981969
Name:JKN ASSISTANT, LLC
Entity type:Organization
Organization Name:JKN ASSISTANT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:210-414-6626
Mailing Address - Street 1:13203 PARK MANOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1530
Mailing Address - Country:US
Mailing Address - Phone:210-414-6626
Mailing Address - Fax:
Practice Address - Street 1:13203 PARK MANOR ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1530
Practice Address - Country:US
Practice Address - Phone:210-414-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMAX ASSISTANT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-24
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00397363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty