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General NPI Number Information
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NPI Number | 1881572014
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Entity Type | Individual
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Provider Name | JASON PATTYSON LPN
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Gender | Male
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 6201 S 39TH ST
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City | ROGERS
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State | AR
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Zip | 72758-1628
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Country | US
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Telephone | 405-210-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 83 W COLT SQUARE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2814
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Country | US
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Telephone | 479-935-1458
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L056757
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License Number State | AR
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