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NPI Code Detail

MEDICARE: JASON TYLER HENDRICKS PA-C

MEDICARE: JASON TYLER HENDRICKS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA.0009729CO

General Provider Information

NPI Number : 1093513582
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON TYLER HENDRICKS PA-C
Provider Business Mailing Address
First Line : 840 SWIFT CT
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80910-4312
Country : US
Telephone Number : 717-606-9598
Fax Number :
Provider Business Practice Location Address
First Line : 175 S UNION BLVD STE 125
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80910-3147
Country : US
Telephone Number : 719-365-1950
Fax Number : 719-365-1951
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2025
Last Update Date : 05/21/2026

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Directions to “ JASON TYLER HENDRICKS PA-C” Practice Location

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