Healthcare Provider Details

I. General information

NPI: 1174055529
Provider Name (Legal Business Name): JASON VINCENT GUEVARA CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7162 LIBERTY CENTRE DR
LIBERTY TOWNSHIP OH
45069-2562
US

IV. Provider business mailing address

1910 FAIRGROVE AVE STE E
HAMILTON OH
45011-1930
US

V. Phone/Fax

Practice location:
  • Phone: 513-795-7557
  • Fax:
Mailing address:
  • Phone: 513-494-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0029442
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number434495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: