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General NPI Number Information
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NPI Number | 1134470388
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Entity Type | Individual
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Provider Name | JOHN RAYMOND ERNST PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 4204 E STAN SCHLUETER LOOP
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City | KILLEEN
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State | TX
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Zip | 76542-8352
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Country | US
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Telephone | 916-742-3215
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Fax |
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Provider Business Mailing Address
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Address Line | 170 DEEP WOOD DR STE 105
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City | ROUND ROCK
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State | TX
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Zip | 78681-4949
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1108109
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License Number State | TX
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