Provider Demographics
NPI:1194161190
Name:CROOK, JASON EUGENE (NP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:EUGENE
Last Name:CROOK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 3616
Mailing Address - Street 2:
Mailing Address - City:MYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84052-9732
Mailing Address - Country:US
Mailing Address - Phone:435-640-2697
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 3616
Practice Address - Street 2:
Practice Address - City:MYTON
Practice Address - State:UT
Practice Address - Zip Code:84052-9732
Practice Address - Country:US
Practice Address - Phone:435-640-2697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001529363L00000X
UT6993029-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner