Provider Demographics
NPI:1710777123
Name:CONDON, COLE AUSTIN (PA-S)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:AUSTIN
Last Name:CONDON
Suffix:
Gender:
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10052 KLIPSTINE RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9584
Mailing Address - Country:US
Mailing Address - Phone:937-564-9423
Mailing Address - Fax:
Practice Address - Street 1:10052 KLIPSTINE RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9584
Practice Address - Country:US
Practice Address - Phone:937-564-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant