Provider Demographics
NPI:1205224870
Name:YOUNG, JASON R (CNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MERCY WAY STE 20
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714-3000
Mailing Address - Country:US
Mailing Address - Phone:479-802-5555
Mailing Address - Fax:479-876-2829
Practice Address - Street 1:1 MERCY WAY STE 20
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3000
Practice Address - Country:US
Practice Address - Phone:479-802-5555
Practice Address - Fax:479-876-2829
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARATP000731363LF0000X
ARA004285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily