Provider Demographics
NPI:1770255283
Name:EMPSON, JASON DANIEL (FNP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:EMPSON
Suffix:
Gender:M
Credentials:FNP
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 952
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0213
Mailing Address - Country:US
Mailing Address - Phone:541-808-1263
Mailing Address - Fax:
Practice Address - Street 1:1900 WOODLAND DR.
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-8808
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPENDING363L00000X
OR202111391NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner