Provider Demographics
NPI:1265038848
Name:FROESCHLE, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FROESCHLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SQUIRREL DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-5394
Mailing Address - Country:US
Mailing Address - Phone:417-699-5111
Mailing Address - Fax:
Practice Address - Street 1:1420 HIGHWAY 62 65 N
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1959
Practice Address - Country:US
Practice Address - Phone:479-463-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO213433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily