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General NPI Number Information
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NPI Number | 1730334475
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Entity Type | Individual
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Provider Name | JASON WESLEY NUGENT MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2008
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 855 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-4913
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Country | US
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Telephone | 316-685-1381
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Fax | 316-866-2495
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Provider Business Mailing Address
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Address Line | 855 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-4913
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Country | US
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Telephone | 316-685-1381
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Fax | 316-866-2495
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7114
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License Number State | KS
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