Provider Demographics
NPI:1467911669
Name:BROWN, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8267 PONDEROSA CT LOT 16
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9484
Mailing Address - Country:US
Mailing Address - Phone:606-547-6149
Mailing Address - Fax:606-329-1530
Practice Address - Street 1:208 4TH ST E
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9430
Practice Address - Country:US
Practice Address - Phone:740-451-0307
Practice Address - Fax:606-329-1530
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist