Provider Demographics
NPI:1417124330
Name:KISER, JASON N (BOCPO/L)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:N
Last Name:KISER
Suffix:
Gender:M
Credentials:BOCPO/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-0937
Mailing Address - Country:US
Mailing Address - Phone:606-833-9631
Mailing Address - Fax:606-836-7561
Practice Address - Street 1:2611 GREENBO BLVD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1830
Practice Address - Country:US
Practice Address - Phone:606-833-9631
Practice Address - Fax:606-836-7561
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier