Healthcare Provider Details

I. General information

NPI: 1144567660
Provider Name (Legal Business Name): JASON DANIEL MCLOTT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 HOSPITAL DR
SPRUCE PINE NC
28777-3035
US

IV. Provider business mailing address

50 SCHENCK PKWY
ASHEVILLE NC
28803-3499
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-4201
  • Fax:
Mailing address:
  • Phone: 828-681-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number258268
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: