Provider Demographics
NPI:1699047852
Name:MARQUART, JASON KELLY (ACNP-BC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:KELLY
Last Name:MARQUART
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAMC-3851 ROGER BROOKE DRIVE
Mailing Address - Street 2:MCHE-QD (CREDS)
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-3390
Mailing Address - Fax:
Practice Address - Street 1:3851 ROGER BROOKE DRIVE
Practice Address - Street 2:MCHE-QD (CREDS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX810728363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care