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General NPI Number Information
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NPI Number | 1346554920
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Entity Type | Individual
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Provider Name | JASON EDWARD KEARNS PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 03/06/2021
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Provider Practice Location Address
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Address Line | 949 E TAFT AVE
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City | SAPULPA
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State | OK
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Zip | 74066-5728
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Country | US
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Telephone | 918-224-6079
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 SHERIDAN DR
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City | JOPLIN
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State | MO
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Zip | 64801-1070
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Country | US
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Telephone | 620-778-0953
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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 | 4521
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-01411
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License Number State | KS
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