Provider Demographics
NPI:1699482364
Name:PRIDDY, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PRIDDY
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 1:404 PUBLIC SQ
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1458
Mailing Address - Country:US
Mailing Address - Phone:270-634-9346
Mailing Address - Fax:
Practice Address - Street 1:404 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1458
Practice Address - Country:US
Practice Address - Phone:270-634-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty