Healthcare Provider Details

I. General information

NPI: 1891526919
Provider Name (Legal Business Name): JARED THOMAS KORT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9792 HIGHWAY 70
MINOCQUA WI
54548-8747
US

IV. Provider business mailing address

1307 N SAINT JOSEPH AVE
MARSHFIELD WI
54449-1340
US

V. Phone/Fax

Practice location:
  • Phone: 715-502-1866
  • Fax: 715-356-9379
Mailing address:
  • Phone: 715-502-1866
  • Fax: 715-356-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8819-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: