Healthcare Provider Details

I. General information

NPI: 1538959630
Provider Name (Legal Business Name): JACOB KELLY ZINK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 W DARTMOUTH ST
OLATHE KS
66061-6869
US

IV. Provider business mailing address

654 BEACHFRONT DR
EVANSVILLE IN
47715-9105
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 913-526-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025035130
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03258
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: