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Individual
JASON P KNISELY
Active
Individual
JASON P KNISELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000501A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11477735
CAQH
IN
05
—
300006046
—
IN
01
—
970020556
RAIL ROAD MEDICARE
IN
Enumeration date
08/17/2005
Last updated
10/30/2018
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