Provider Demographics
NPI:1225149073
Name:BERREMAN, JASON L (ARNP C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:L
Last Name:BERREMAN
Suffix:
Gender:M
Credentials:ARNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 KERN WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7805
Mailing Address - Country:US
Mailing Address - Phone:509-248-4303
Mailing Address - Fax:509-469-2441
Practice Address - Street 1:3810 KERN WAY
Practice Address - Street 2:SUITE D
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7805
Practice Address - Country:US
Practice Address - Phone:509-248-4303
Practice Address - Fax:509-469-2441
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00133747363L00000X
WAAP300061DS363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P67565Medicare UPIN
WAGAB32933Medicare ID - Type Unspecified