Provider Demographics
NPI:1235244971
Name:POMONIS, JASON NICK (FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:NICK
Last Name:POMONIS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6025 METROPOLITAN DR STE 205
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2409
Mailing Address - Country:US
Mailing Address - Phone:409-234-7088
Mailing Address - Fax:409-898-0177
Practice Address - Street 1:6025 METROPOLITAN DR STE 205
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2409
Practice Address - Country:US
Practice Address - Phone:409-234-7088
Practice Address - Fax:409-898-0177
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10059111N00000X
TX1046352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB102548Medicare PIN