Provider Demographics
NPI:1982981254
Name:PELPHREY, JASON (LPN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:PELPHREY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1613
Mailing Address - Country:US
Mailing Address - Phone:937-684-9670
Mailing Address - Fax:
Practice Address - Street 1:34 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1613
Practice Address - Country:US
Practice Address - Phone:937-684-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.131511IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse