Provider Demographics
NPI:1295480630
Name:EASON, JEFFREY (FNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:EASON
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 1:206 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-2227
Mailing Address - Fax:662-534-2330
Practice Address - Street 1:6515 POPLAR AVE STE 106
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4878
Practice Address - Country:US
Practice Address - Phone:901-426-1090
Practice Address - Fax:901-426-1091
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905299363L00000X
TN31166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner