Provider Demographics
NPI:1356755094
Name:NAKKEN, JASON JON (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JON
Last Name:NAKKEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 N UNIVERSITY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6601
Mailing Address - Country:US
Mailing Address - Phone:801-356-6100
Mailing Address - Fax:
Practice Address - Street 1:3585 N UNIVERSITY AVE STE 105
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6601
Practice Address - Country:US
Practice Address - Phone:801-356-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0050303207L00000X
UT11085893-1204207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology