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
1	363A00000X	Physician Assistant	PA.0009729	CO

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	:	1650 COCHRANE CIR UNIT MEDDAC
Second Line	:
City	:	FT CARSON
State	:	CO
Zip	:	80913-4604
Country	:	US
Telephone Number	:	719-526-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/02/2026

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