Basic Information
| Provider Information | |||||||||
| NPI: | 1043974314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOUSE | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | CRNA, DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1077 DUVAL ST APT 101 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405156482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595821118 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 ROSE STREET | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235956 | ||||||||
| FaxNumber: | 8593231080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2021 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1153811 | KY | N | Nursing Service Providers | Registered Nurse | 367500000X | 3018307 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.