MEDICARE: MR. JASON ALLEN MCCAIN MSN, AGPCNP

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	363L00000X	Nurse Practitioner	904153	MS

General Provider Information

NPI Number	:	1740896745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON ALLEN MCCAIN MSN, AGPCNP

Provider Business Mailing Address
First Line	:	297 COUNTY ROAD 244
Second Line	:
City	:	ETTA
State	:	MS
Zip	:	38627-9523
Country	:	US
Telephone Number	:	662-281-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 COUNTY ROAD 244
Second Line	:
City	:	ETTA
State	:	MS
Zip	:	38627-9523
Country	:	US
Telephone Number	:	662-281-9992
Fax Number	:

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

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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