Basic Information
| Provider Information | |||||||||
| NPI: | 1659324663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAEGER | ||||||||
| FirstName: | DUANE | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ARNP, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 SHADY WAY | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166513621 | ||||||||
| FaxNumber: | 3166815570 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 E KELLOGG DR | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672181607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166513621 | ||||||||
| FaxNumber: | 3166815570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 74618 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 74618 | 01 | KS | PSYCHIATRIC CERTIFICATION | OTHER | 14-052505-012 | 01 | KS | RN LICENSE | OTHER |