Provider Demographics
NPI:1134412059
Name:WHITSON, JASON KIMBLE (RN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:KIMBLE
Last Name:WHITSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 NE 68TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0323
Mailing Address - Country:US
Mailing Address - Phone:360-693-0493
Mailing Address - Fax:
Practice Address - Street 1:2616 NE 68TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0323
Practice Address - Country:US
Practice Address - Phone:360-693-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201042388RN163W00000X, 163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163W00000XNursing Service ProvidersRegistered Nurse