Provider Demographics
NPI:1730728841
Name:CALLOWAY, JASON (APRN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CALLOWAY
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 1:2880 BICENTENNIAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-4484
Mailing Address - Country:US
Mailing Address - Phone:310-651-4279
Mailing Address - Fax:855-592-1100
Practice Address - Street 1:4760 S PECOS RD # 103-23
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6038
Practice Address - Country:US
Practice Address - Phone:800-820-5793
Practice Address - Fax:855-592-1100
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV834379363L00000X, 363LP0808X
CA9514307363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner