Provider Demographics
NPI:1962546069
Name:EASTER, JANEEN N (PA-C)
Entity type:Individual
Prefix:
First Name:JANEEN
Middle Name:N
Last Name:EASTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 DUVAL RD
Mailing Address - Street 2:BLDG 3, SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3550
Mailing Address - Country:US
Mailing Address - Phone:512-485-7200
Mailing Address - Fax:
Practice Address - Street 1:4100 DUVAL RD
Practice Address - Street 2:BLDG 3, STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3550
Practice Address - Country:US
Practice Address - Phone:512-485-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical