Provider Demographics
NPI:1609293240
Name:FORD, JASON (LPN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 ROSE OF SHARON CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-8216
Mailing Address - Country:US
Mailing Address - Phone:336-253-3354
Mailing Address - Fax:
Practice Address - Street 1:1317 ROSE OF SHARON CT
Practice Address - Street 2:
Practice Address - City:PLEASANT GARDEN
Practice Address - State:NC
Practice Address - Zip Code:27313-8216
Practice Address - Country:US
Practice Address - Phone:336-253-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65748164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse