MEDICARE: JASON ROBERTS

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.15901	OH

General Provider Information

NPI Number	:	1801208004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ROBERTS

Provider Business Mailing Address
First Line	:	6427 RING NECK DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-4198
Country	:	US
Telephone Number	:	937-409-1321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 BELLEFONTAINE AVE
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-2800
Country	:	US
Telephone Number	:	491-228-3335
Fax Number	:

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

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	06/12/2026

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Directions to “ JASON ROBERTS ” Practice Location

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