Individual
JASON D HERMRECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7550 W VILLAGE CIR STE 1, WICHITA, KS 67205-9364
(316) 838-2020
Mailing address
7550 W VILLAGE CIR STE 1, WICHITA, KS 67205-9364
(316) 838-2020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-02897
KANSAS PHYSICIAN ASSISTANT LICENSE
KS
05
—
3000513930001
—
KS
Enumeration date
06/04/2022
Last updated
06/11/2024
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