Provider Demographics
NPI:1427453836
Name:KING, JAN MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JAN
Other - Middle Name:MARIE
Other - Last Name:DUBENSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:952 GRUENE RD
Mailing Address - Street 2:STE 150
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-626-9911
Mailing Address - Fax:830-626-9922
Practice Address - Street 1:952 GRUENE RD
Practice Address - Street 2:STE 150
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-626-9911
Practice Address - Fax:830-626-9922
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
TXPA09358363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical