Provider Demographics
NPI:1659991313
Name:PRATT, JASON (APRN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BRECKENRIDGE LN STE 147
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4175
Mailing Address - Country:US
Mailing Address - Phone:502-708-1904
Mailing Address - Fax:
Practice Address - Street 1:4400 BRECKENRIDGE LN STE 147
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4175
Practice Address - Country:US
Practice Address - Phone:502-708-1904
Practice Address - Fax:502-708-2547
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014516363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3014516Medicaid