Healthcare Provider Details

I. General information

NPI: 1346554920
Provider Name (Legal Business Name): JASON EDWARD KEARNS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NW BLUE PKWY
LEES SUMMIT MO
64086-5713
US

IV. Provider business mailing address

1202 SHERIDAN DR
JOPLIN MO
64801-1070
US

V. Phone/Fax

Practice location:
  • Phone: 913-297-7472
  • Fax:
Mailing address:
  • Phone: 620-778-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01411
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4521
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: