Individual
JONATHON RUSSELL KORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
46439 275 AVE, HUMPHREY, NE 68642-5003
(402) 920-2926
Mailing address
46439 275 AVE, HUMPHREY, NE 68642-5003
(402) 920-2926
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2865
NE
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
1942925516
NE
Other
Enumeration date
10/06/2022
Last updated
03/01/2023
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