Provider Demographics
NPI:1992401582
Name:ADAMS, R JASON (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:R JASON
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N MACDONALD STE 204
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7343
Mailing Address - Country:US
Mailing Address - Phone:480-758-4698
Mailing Address - Fax:
Practice Address - Street 1:1 N MACDONALD STE 204
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7343
Practice Address - Country:US
Practice Address - Phone:480-758-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ288390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty