Provider Demographics
NPI:1932731809
Name:CARPENTER, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CARPENTER
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 1:653 MCCORKLE BLVD UNIT G
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7159
Mailing Address - Country:US
Mailing Address - Phone:614-771-8605
Mailing Address - Fax:
Practice Address - Street 1:653 MCCORKLE BLVD UNIT G
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7159
Practice Address - Country:US
Practice Address - Phone:614-771-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider