Provider Demographics
NPI:1699650424
Name:BURGE, JASON ALLEN (APRN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALLEN
Last Name:BURGE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8632 S 4950 W
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4865
Mailing Address - Country:US
Mailing Address - Phone:385-787-9342
Mailing Address - Fax:
Practice Address - Street 1:8632 S 4950 W
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4865
Practice Address - Country:US
Practice Address - Phone:385-787-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11101003-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily