Provider Demographics
NPI:1881266534
Name:BLEVINS, JASON
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:BLEVINS
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 1:12131 BRIGHTON BROOK LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2583
Mailing Address - Country:US
Mailing Address - Phone:910-690-9142
Mailing Address - Fax:346-236-0406
Practice Address - Street 1:12131 BRIGHTON BROOK LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-2583
Practice Address - Country:US
Practice Address - Phone:346-808-7675
Practice Address - Fax:346-236-0406
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty