Healthcare Provider Details

I. General information

NPI: 1215236740
Provider Name (Legal Business Name): JAYNE LAUREN ASCHEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD SUITE 320A
SAINT LOUIS MO
63131-2322
US

IV. Provider business mailing address

3009 N BALLAS RD SUITE 320A
SAINT LOUIS MO
63131-2322
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-7707
  • Fax: 314-432-2564
Mailing address:
  • Phone: 314-991-7707
  • Fax: 314-432-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2011007196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: