Healthcare Provider Details

I. General information

NPI: 1831070077
Provider Name (Legal Business Name): JASON LAWRENCE JOSHUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 MILLER VALLEY RD
PRESCOTT AZ
86301-1813
US

IV. Provider business mailing address

743 MILLER VALLEY RD
PRESCOTT AZ
86301-1813
US

V. Phone/Fax

Practice location:
  • Phone: 928-777-9600
  • Fax: 855-449-5560
Mailing address:
  • Phone: 928-777-9600
  • Fax: 855-449-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number285505
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: