Provider Demographics
NPI:1932907755
Name:RHODES, JASON (CHW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W CONNALLY ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1312
Mailing Address - Country:US
Mailing Address - Phone:903-944-0803
Mailing Address - Fax:
Practice Address - Street 1:1200 W CONNALLY ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1312
Practice Address - Country:US
Practice Address - Phone:903-944-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12917172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker