Healthcare Provider Details

I. General information

NPI: 1972242683
Provider Name (Legal Business Name): MICHAEL JASPER MASON CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N GRANT AVE
COLUMBUS OH
43215-2641
US

IV. Provider business mailing address

245 N GRANT AVE
COLUMBUS OH
43215-2641
US

V. Phone/Fax

Practice location:
  • Phone: 614-445-8131
  • Fax:
Mailing address:
  • Phone: 614-445-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0031185
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: