Provider Demographics
NPI:1740896745
Name:MCCAIN, JASON ALLEN (MSN, AGPCNP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALLEN
Last Name:MCCAIN
Suffix:
Gender:M
Credentials:MSN, AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 COUNTY ROAD 244
Mailing Address - Street 2:
Mailing Address - City:ETTA
Mailing Address - State:MS
Mailing Address - Zip Code:38627-9523
Mailing Address - Country:US
Mailing Address - Phone:662-281-9992
Mailing Address - Fax:
Practice Address - Street 1:297 COUNTY ROAD 244
Practice Address - Street 2:
Practice Address - City:ETTA
Practice Address - State:MS
Practice Address - Zip Code:38627-9523
Practice Address - Country:US
Practice Address - Phone:662-281-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner