Healthcare Provider Details

I. General information

NPI: 1841663903
Provider Name (Legal Business Name): JASON P KNOWLES PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 GREAT RD STE G1
ACTON MA
01720-4766
US

IV. Provider business mailing address

289 GREAT RD STE G1
ACTON MA
01720-4766
US

V. Phone/Fax

Practice location:
  • Phone: 978-679-1200
  • Fax: 978-486-4037
Mailing address:
  • Phone: 978-679-1200
  • Fax: 978-486-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2328831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: