Provider Demographics
NPI:1184202004
Name:PHILLIPS, JASON LOUIS (CRNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LOUIS
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 ROUTE 6 STE 3
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-7031
Mailing Address - Country:US
Mailing Address - Phone:570-229-0774
Mailing Address - Fax:
Practice Address - Street 1:2531 ROUTE 6 STE 3
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7031
Practice Address - Country:US
Practice Address - Phone:570-855-8074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022922363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care