Provider Demographics
NPI:1194846899
Name:DESKINS, JASON R (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:DESKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 HIGHWAY 644
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-9242
Mailing Address - Country:US
Mailing Address - Phone:606-638-4656
Mailing Address - Fax:
Practice Address - Street 1:2485 HIGHWAY 644
Practice Address - Street 2:SUITE 108
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-9242
Practice Address - Country:US
Practice Address - Phone:606-638-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03210207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine