Provider Demographics
NPI:1578158465
Name:ITSON, JASON PATRICK SR (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:PATRICK
Last Name:ITSON
Suffix:SR
Gender:M
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8034 CEDAR EDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5852
Mailing Address - Country:US
Mailing Address - Phone:540-330-4455
Mailing Address - Fax:
Practice Address - Street 1:3133 YARDLEY DR NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2309
Practice Address - Country:US
Practice Address - Phone:540-330-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001270289163W00000X
VA0024182828363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse