MEDICARE: JASON BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		KY

General Provider Information

NPI Number	:	1467911669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON BROWN

Provider Business Mailing Address
First Line	:	8267 PONDEROSA CT LOT 16
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102-9484
Country	:	US
Telephone Number	:	606-547-6149
Fax Number	:	606-329-1530

Provider Business Practice Location Address
First Line	:	208 4TH ST E
Second Line	:
City	:	SOUTH POINT
State	:	OH
Zip	:	45680-9430
Country	:	US
Telephone Number	:	740-451-0307
Fax Number	:	606-329-1530

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	12/06/2024

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Directions to “ JASON BROWN ” Practice Location

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