Provider Demographics
NPI:1285267583
Name:GREEN, JASON ALLEN (DNP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALLEN
Last Name:GREEN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ASHLAND WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3357
Mailing Address - Country:US
Mailing Address - Phone:985-871-5955
Mailing Address - Fax:
Practice Address - Street 1:101 ASHLAND WAY STE 1
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3357
Practice Address - Country:US
Practice Address - Phone:985-871-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206364363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care