Provider Demographics
NPI:1558195503
Name:MCWHORTER, JASON WADE
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WADE
Last Name:MCWHORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2926
Mailing Address - Country:US
Mailing Address - Phone:641-494-5415
Mailing Address - Fax:641-494-5413
Practice Address - Street 1:250 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2926
Practice Address - Country:US
Practice Address - Phone:641-494-5300
Practice Address - Fax:641-494-5403
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH181115363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care