Provider Demographics
NPI:1730412396
Name:KONEMAN, JASON WAYNE (CPHT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:WAYNE
Last Name:KONEMAN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-0033
Mailing Address - Country:US
Mailing Address - Phone:512-981-5828
Mailing Address - Fax:512-541-2868
Practice Address - Street 1:10101 W PARMER LN APT 1314
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5031
Practice Address - Country:US
Practice Address - Phone:512-981-5828
Practice Address - Fax:512-541-2868
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174H00000X, 305S00000X, 171M00000X
TX102114183700000X, 183700000X
260101030750018183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No305S00000XManaged Care OrganizationsPoint of Service
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102114OtherTEXAS STATE BOARD OF PHARMACY