Provider Demographics
NPI:1053788901
Name:JACKMAN, LINSEY (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:LINSEY
Middle Name:
Last Name:JACKMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:LINSEY
Other - Middle Name:
Other - Last Name:BAHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0946
Mailing Address - Country:US
Mailing Address - Phone:620-431-2500
Mailing Address - Fax:620-431-4418
Practice Address - Street 1:505 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720
Practice Address - Country:US
Practice Address - Phone:620-431-2500
Practice Address - Fax:620-431-4418
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant