Healthcare Provider Details

I. General information

NPI: 1861928038
Provider Name (Legal Business Name): JASON NOPE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 BREWER AVENUE
MOUNTAIN VIEW AR
72560
US

IV. Provider business mailing address

217A BREWER AVENUE
MOUNTAIN VIEW AR
72560
US

V. Phone/Fax

Practice location:
  • Phone: 605-381-2978
  • Fax:
Mailing address:
  • Phone: 605-381-2978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR100955
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: