Provider Demographics
NPI:1851448906
Name:BOX, JASON S (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:S
Last Name:BOX
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-1007
Mailing Address - Country:US
Mailing Address - Phone:601-947-1332
Mailing Address - Fax:601-947-1331
Practice Address - Street 1:1017 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:LEAKESVILLE
Practice Address - State:MS
Practice Address - Zip Code:39451-9105
Practice Address - Country:US
Practice Address - Phone:601-394-2820
Practice Address - Fax:601-394-2748
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00027266Medicaid
MS302I504028Medicare Oscar/Certification
500002345Medicare PIN