MEDICARE: JASON PRATT APRN

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	363LP2300X	Primary Care Nurse Practitioner	3014516	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659991313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON PRATT APRN

Provider Business Mailing Address
First Line	:	12910 FACTORY LN STE 208
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-2048
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12910 FACTORY LN STE 208
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-2048
Country	:	US
Telephone Number	:	502-432-7755
Fax Number	:

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

Provider Enumeration Date	:	04/23/2020
Last Update Date	:	06/26/2026

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Directions to “ JASON PRATT APRN” Practice Location

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