=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194225516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON REED PAINTER CRNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2018
-----------------------------------------------------
Last Update Date | 02/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2494 BERNVILLE RD
-----------------------------------------------------
City | READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-208-4646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 HANNUM RD
-----------------------------------------------------
City | KENNETT SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-319-7647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | SP018296
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------