Provider Demographics
NPI:1841663903
Name:KNOWLES, JASON P (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 GREAT RD STE G1
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4766
Mailing Address - Country:US
Mailing Address - Phone:978-679-1200
Mailing Address - Fax:978-486-4037
Practice Address - Street 1:289 GREAT RD STE G1
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4766
Practice Address - Country:US
Practice Address - Phone:978-679-1200
Practice Address - Fax:978-486-4037
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2328831363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health