Healthcare Provider Details

I. General information

NPI: 1497188106
Provider Name (Legal Business Name): JASON D SWEAZY MS, BSN, BA, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S PERRYVILLE RD STE 130
ROCKFORD IL
61108-2527
US

IV. Provider business mailing address

555 S PERRYVILLE RD STE 130
ROCKFORD IL
61108-2527
US

V. Phone/Fax

Practice location:
  • Phone: 815-404-3452
  • Fax:
Mailing address:
  • Phone: 815-404-3452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002535
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.524448
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number757959
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36768.1471
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402523
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: