MEDICARE: JOHN RUSSELL KLENS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	50.007162RX	OH
2	363A00000X	Physician Assistant	50.007162RX	OH

General Provider Information

NPI Number	:	1528737376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RUSSELL KLENS PA-C

Provider Business Mailing Address
First Line	:	1 WYOMING ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2722
Country	:	US
Telephone Number	:	937-208-3356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 WYOMING ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2722
Country	:	US
Telephone Number	:	937-208-3356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2021
Last Update Date	:	01/02/2026

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