Healthcare Provider Details

I. General information

NPI: 1992401582
Provider Name (Legal Business Name): R JASON ADAMS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 247
GILBERT AZ
85295-3214
US

IV. Provider business mailing address

1760 E PECOS RD STE 247
GILBERT AZ
85295-3214
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-7584
  • Fax:
Mailing address:
  • Phone: 480-626-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number288390
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: