Provider Demographics
NPI:1194049510
Name:JASON BERREMAN, ARNP, PS
Entity type:Organization
Organization Name:JASON BERREMAN, ARNP, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ARNP
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BERREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-248-4303
Mailing Address - Street 1:3810 KERN WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7805
Mailing Address - Country:US
Mailing Address - Phone:509-248-4303
Mailing Address - Fax:509-469-2441
Practice Address - Street 1:3810 KERN WAY
Practice Address - Street 2:SUITE D
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7805
Practice Address - Country:US
Practice Address - Phone:509-248-4303
Practice Address - Fax:509-469-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006105261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty