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NPI Code Detail

MEDICARE: JARED ROBERT SISSON PA

MEDICARE: JARED ROBERT SISSON PA
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
1363AM0700XMedical Physician Assistant029543NY
2363AS0400XSurgical Physician AssistantPA18209TX
3363AM0700XMedical Physician AssistantPA18209TX

General Provider Information

NPI Number : 1356040042
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED ROBERT SISSON PA
Provider Business Mailing Address
First Line : 507 VIRGINIA DR
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-3048
Country : US
Telephone Number : 512-915-0538
Fax Number :
Provider Business Practice Location Address
First Line : 911 W 38TH ST STE 300
Second Line :
City : AUSTIN
State : TX
Zip : 78705-1161
Country : US
Telephone Number : 512-439-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2023
Last Update Date : 12/23/2024

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Directions to “ JARED ROBERT SISSON PA” Practice Location

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