Provider Demographics
NPI:1497347314
Name:ROY, JASON DOUGLAS (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DOUGLAS
Last Name:ROY
Suffix:
Gender:M
Credentials:FNP-C
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 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-6000
Mailing Address - Fax:
Practice Address - Street 1:510 CAROLINA BAY DR STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2046
Practice Address - Country:US
Practice Address - Phone:910-662-6000
Practice Address - Fax:910-662-9703
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006418146L00000X
NC242594163WF0300X
NC5014072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WF0300XNursing Service ProvidersRegistered NurseFlight