Provider Demographics
NPI:1568865749
Name:KJOS, LAUREN ASHLI (PA-C)
Entity type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ASHLI
Last Name:KJOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15044 WILSON HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947
Mailing Address - Country:US
Mailing Address - Phone:302-841-8917
Mailing Address - Fax:
Practice Address - Street 1:1412-22 FAIRMOUNT AVENUE
Practice Address - Street 2:DELAWARE VALLEY COMMUNITY HEALTH
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:215-684-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant