Individual
JASON DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
23401 PRAIRIE STAR PKWY STE B-300, LENEXA, KS 66227-7268
(913) 677-6319
(913) 677-1540
Mailing address
23401 PRAIRIE STAR PKWY STE B-300, LENEXA, KS 66227-7268
(913) 677-6319
(913) 677-1450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1501587
KS
363A00000X
Physician Assistant
Primary
2012021523
MO
Other
Enumeration date
07/13/2012
Last updated
08/29/2024
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