Provider Demographics
NPI:1427198852
Name:JASPER, CARY (ANP, ND)
Entity type:Individual
Prefix:
First Name:CARY
Middle Name:
Last Name:JASPER
Suffix:
Gender:M
Credentials:ANP, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 KRESKY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3723
Mailing Address - Country:US
Mailing Address - Phone:602-642-4923
Mailing Address - Fax:
Practice Address - Street 1:1006 KRESKY AVE STE 1
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3723
Practice Address - Country:US
Practice Address - Phone:360-264-2492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK345363L00000X
WAAP60233048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2069719Medicaid
AKNP1512Medicaid
AKS45031Medicare UPIN