Provider Demographics
NPI:1285836478
Name:MATTERN, JASON C SR (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:MATTERN
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:787 WEATHERLY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8949
Practice Address - Country:US
Practice Address - Phone:931-647-1255
Practice Address - Fax:931-647-2399
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6091953OtherBCBS TN
TN1524510Medicaid
6039665OtherBLUECROSS
TN103I974107Medicare PIN