MEDICARE: JASON RYAN FELT AG-ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	NP95031072	CA
2	163W00000X	Registered Nurse	RN60291550	WA

General Provider Information

NPI Number	:	1467166546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON RYAN FELT AG-ACNP

Provider Business Mailing Address
First Line	:	PO BOX 50938
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-0938
Country	:	US
Telephone Number	:	323-442-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SAN PABLO ST FL 4
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5313
Country	:	US
Telephone Number	:	323-442-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	04/18/2026

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