Healthcare Provider Details

I. General information

NPI: 1194494914
Provider Name (Legal Business Name): JAY MASON MOUNTEER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax: 202-715-4015
Mailing address:
  • Phone: 202-715-4000
  • Fax: 202-715-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN1042186
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1042186
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1042186
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: