Individual
JYNNA J ULRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
15-01772
KS
363AM0700X
Medical Physician Assistant
Primary
PA05064
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719365
MEDICARE
KS
05
—
201108990A
—
KS
01
—
PA05064
LICENSE
TX
Enumeration date
01/30/2007
Last updated
08/11/2023
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