Provider Demographics
NPI:1285274167
Name:WHITNEY, JASON LOREN (ARNP FNP-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LOREN
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2367
Mailing Address - Country:US
Mailing Address - Phone:360-414-2385
Mailing Address - Fax:
Practice Address - Street 1:13051 US HWY 12
Practice Address - Street 2:STE 2
Practice Address - City:PACKWOOD
Practice Address - State:WA
Practice Address - Zip Code:98361
Practice Address - Country:US
Practice Address - Phone:360-496-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61034006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP61034006Medicaid