Provider Demographics
NPI:1598135782
Name:NOLES, JASON KENT (RN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:KENT
Last Name:NOLES
Suffix:
Gender:
Credentials:RN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-7593
Mailing Address - Fax:503-346-8021
Practice Address - Street 1:2901 SQUALICUM PKWY STE 3041
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-788-6841
Practice Address - Fax:360-788-6847
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60783819163W00000X, 163W00000X
WAAP60794614363L00000X, 363L00000X
OR201604305NP-PP363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner