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NPI Code Detail

MEDICARE: JACOB KELLY ZINK PA

MEDICARE: JACOB KELLY ZINK 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
1363A00000XPhysician Assistant2025035130MO
2363A00000XPhysician Assistant15-03258KS

General Provider Information

NPI Number : 1538959630
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB KELLY ZINK PA
Provider Business Mailing Address
First Line : 654 BEACHFRONT DR
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-9105
Country : US
Telephone Number : 913-526-6744
Fax Number :
Provider Business Practice Location Address
First Line : 2090 W DARTMOUTH ST
Second Line :
City : OLATHE
State : KS
Zip : 66061-6869
Country : US
Telephone Number : 913-588-1227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2025
Last Update Date : 05/26/2026

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