Healthcare Provider Details

I. General information

NPI: 1386335792
Provider Name (Legal Business Name): CARY JASPER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 KRESKY AVE STE 1
CENTRALIA WA
98531-3723
US

IV. Provider business mailing address

1006 KRESKY AVE STE 1
CENTRALIA WA
98531-3723
US

V. Phone/Fax

Practice location:
  • Phone: 360-264-2492
  • Fax:
Mailing address:
  • Phone: 360-264-2492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARY JASPER
Title or Position: OWNER/FNP
Credential: FNP
Phone: 907-244-9901