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General NPI Number Information
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NPI Number | 1982321873
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Entity Type | Individual
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Provider Name | JASON MARSH PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 190 OVERTHRUST RD
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City | EVANSTON
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State | WY
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Zip | 82930
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Country | US
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Telephone | 307-789-4224
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Fax |
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Provider Business Mailing Address
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Address Line | 190 OVERTHRUST RD
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City | EVANSTON
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State | WY
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Zip | 82930-9260
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Country | US
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Telephone | 307-789-4224
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Fax | 307-789-4225
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 46569
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License Number State | WY
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