Healthcare Provider Details

I. General information

NPI: 1427198852
Provider Name (Legal Business Name): CARY JASPER A.N.P., N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
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: 602-642-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number345
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60233048
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: