Provider Demographics
NPI:1659991313
Name:PRATT, JASON (APRN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E VAN TREES ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-3100
Mailing Address - Country:US
Mailing Address - Phone:812-250-1818
Mailing Address - Fax:
Practice Address - Street 1:4919 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9426
Practice Address - Country:US
Practice Address - Phone:812-250-1818
Practice Address - Fax:812-777-4504
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014516363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3014516Medicaid