Healthcare Provider Details

I. General information

NPI: 1154548170
Provider Name (Legal Business Name): JASON SIMS RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

885 WINDING OAK TRL
LEXINGTON KY
40511-8959
US

V. Phone/Fax

Practice location:
  • Phone: 859-509-1141
  • Fax: 859-509-1141
Mailing address:
  • Phone: 859-509-1141
  • Fax: 859-509-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number1094005
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: