Provider Demographics
NPI:1780762021
Name:HAMONS, JENNIFER L (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HAMONS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1719 HWY 183
Mailing Address - Street 2:P.O. BOX 547
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-0547
Mailing Address - Country:US
Mailing Address - Phone:785-543-5211
Mailing Address - Fax:785-543-5274
Practice Address - Street 1:1719 HWY 183
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-0547
Practice Address - Country:US
Practice Address - Phone:785-543-5211
Practice Address - Fax:785-543-5274
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501129363A00000X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS427044OtherBLUE CROSS BLUE SHIELD
KS200407500AMedicaid
KS200407500AMedicaid