Healthcare Provider Details

I. General information

NPI: 1629524103
Provider Name (Legal Business Name): JENNIFER LYNNE DUTTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S CLIFTON AVE STE 205
WICHITA KS
67218-2958
US

IV. Provider business mailing address

1515 S CLIFTON AVE STE 205
WICHITA KS
67218-2958
US

V. Phone/Fax

Practice location:
  • Phone: 316-274-8989
  • Fax: 316-221-5696
Mailing address:
  • Phone: 316-274-8989
  • Fax: 316-221-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: