Healthcare Provider Details

I. General information

NPI: 1659324663
Provider Name (Legal Business Name): DUANE C JAEGER ARNP, BC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E KELLOGG DR
WICHITA KS
67218-1607
US

IV. Provider business mailing address

828 SHADY WAY
WICHITA KS
67203-3416
US

V. Phone/Fax

Practice location:
  • Phone: 316-651-3621
  • Fax: 316-681-5570
Mailing address:
  • Phone: 316-651-3621
  • Fax: 316-681-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number74618
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: