Knisely, Jason P

Knisely, Jason P is an individual health care provider with primary practice located at 5050 N Clinton St , Fort Wayne IN 46825-5886. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Knisely, Jason P can be contacted via phone (260) 484-8551.

Contact Information

Primary practice address
5050 N Clinton St Fort Wayne IN 46825-5886
Phone: (260) 484-8551
Fax: (260) 484-9603
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10000501A Indiana

Profile Details

NPI number 1205828001
LBN Legal business name Knisely, Jason P
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 17th, 2005
Last updated Oct 30th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205828001 NPPES
Indiana Other 970020556 RAIL ROAD MEDICARE
Indiana MEDICAID 300006046 RAIL ROAD MEDICARE
Indiana Other 11477735 RAIL ROAD MEDICARE

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