Provider Demographics
NPI:1962592972
Name:DELONG, JASON E (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:DELONG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1378
Mailing Address - Country:US
Mailing Address - Phone:859-737-5333
Mailing Address - Fax:859-737-0070
Practice Address - Street 1:404 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1301
Practice Address - Country:US
Practice Address - Phone:859-737-5333
Practice Address - Fax:859-737-0070
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
7941229OtherAETNA PROVIDER ID
KY2092375OtherWELLCARE
KYQMP000005624542OtherMOLINA
KY95004339Medicaid
KY000000324312OtherANTHEM BCBS PROVIDER ID
KYCS1914400188OtherCARESOURCE
KYP400023815Medicare PIN
KY7500Medicare PIN
200312945OtherFEDERAL TAX ID
KY95004339Medicaid
KY0796302Medicare PIN