Black, Jason L

Black, Jason L is an individual health care provider with primary practice located at 1407 W Baddour Pkwy , Lebanon TN 37087-2513. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Black, Jason L can be contacted via phone (615) 444-6203.

Contact Information

Primary practice address
1407 W Baddour Pkwy Lebanon TN 37087-2513
Phone: (615) 444-6203
Fax: (615) 444-6252
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP145757 Texas
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 12510 Tennessee

Profile Details

NPI number 1306013305
LBN Legal business name Black, Jason L
Credentials APRN-C
Entity Individual
Sole proprietor 1 No
Enumeration date May 9th, 2008
Last updated Jun 11th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306013305 NPPES
Tennessee MEDICAID 1524683
Tennessee Other 270851352
Tennessee Other 4298132
Tennessee Other 1671330
Tennessee Other 141492
Tennessee Other 3323078
Tennessee Other 12242516
Tennessee Other 62-1792161
Tennessee Other 12510

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