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General NPI Number Information
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NPI Number | 1356040042
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Entity Type | Individual
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Provider Name | JARED ROBERT SISSON PA
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Gender | Male
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 911 W 38TH ST STE 300
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City | AUSTIN
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State | TX
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Zip | 78705-1161
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Country | US
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Telephone | 512-439-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 507 VIRGINIA DR
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City | ROUND ROCK
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State | TX
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Zip | 78664-3048
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Country | US
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Telephone | 512-915-0538
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 029543
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA18209
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA18209
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License Number State | TX
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