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General NPI Number Information
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NPI Number | 1205224870
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Entity Type | Individual
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Provider Name | JASON R YOUNG CNP
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Gender | Male
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 1 MERCY WAY STE 20
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City | BELLA VISTA
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State | AR
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Zip | 72714-3000
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Country | US
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Telephone | 479-802-5555
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Fax | 479-876-2829
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Provider Business Mailing Address
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Address Line | 1 MERCY WAY STE 20
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City | BELLA VISTA
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State | AR
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Zip | 72714-3000
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Country | US
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Telephone | 479-802-5555
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Fax | 479-876-2829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ATP000731
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A004285
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License Number State | AR
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