Healthcare Provider Details

I. General information

NPI: 1558882019
Provider Name (Legal Business Name): JASON NEAL MCCRAY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 HOLTON AVE E
BIG STONE GAP VA
24219-3350
US

IV. Provider business mailing address

112 VICTOR DR
BRISTOL TN
37620-4739
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-3111
  • Fax:
Mailing address:
  • Phone: 423-797-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22868
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174973
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22868
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: