Healthcare Provider Details

I. General information

NPI: 1750210225
Provider Name (Legal Business Name): JASON PERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S COUNTRY CLUB AVE
BRANDON SD
57005-6647
US

IV. Provider business mailing address

404 S COUNTRY CLUB AVE
BRANDON SD
57005-6647
US

V. Phone/Fax

Practice location:
  • Phone: 605-222-6597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: