Provider Demographics
NPI:1265692438
Name:SHUFFITT, JASON T (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:SHUFFITT
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1212 ASHLEY CIR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5821
Mailing Address - Country:US
Mailing Address - Phone:270-228-0992
Mailing Address - Fax:270-854-1835
Practice Address - Street 1:1212 ASHLEY CIR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5821
Practice Address - Country:US
Practice Address - Phone:270-228-0992
Practice Address - Fax:270-854-1835
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3005814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100037790Medicaid
KY7100037790Medicaid