Provider Demographics
NPI:1871935189
Name:CARR, JASON EVAN (NP)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:EVAN
Last Name:CARR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5463
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:6941 HIGHWAY 11
Practice Address - Street 2:SUITE A
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-7793
Practice Address - Country:US
Practice Address - Phone:601-794-3714
Practice Address - Fax:601-749-3776
Is Sole Proprietor?:No
Enumeration Date:2013-07-28
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06437250Medicaid
MS1871935189Medicare PIN