Healthcare Provider Details

I. General information

NPI: 1881009579
Provider Name (Legal Business Name): STEVEN ANTHONY JAECKLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 E WHITESTONE BLVD BLDG 2
CEDAR PARK TX
78613-6934
US

IV. Provider business mailing address

6406 N IH 35 STE 2600
AUSTIN TX
78752-4337
US

V. Phone/Fax

Practice location:
  • Phone: 512-652-0050
  • Fax: 737-220-7850
Mailing address:
  • Phone: 512-465-4800
  • Fax: 512-420-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14927
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017575
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1734
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: