Provider Demographics
NPI:1306996780
Name:BADER, JENNIFER CASERTA (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CASERTA
Last Name:BADER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:CASERTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1510 W 34TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1400
Mailing Address - Country:US
Mailing Address - Phone:512-533-9900
Mailing Address - Fax:512-533-9901
Practice Address - Street 1:1510 W 34TH ST
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1400
Practice Address - Country:US
Practice Address - Phone:512-533-9900
Practice Address - Fax:512-533-9901
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001863363A00000X
TXPA05397363AS0400X
AZ4948363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346354901Medicaid
TX8K1133Medicare PIN