Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 3004629 | KY |
NPI | 1003986167 |
---|---|
Provider Name | Jason K Freeburne |
First Address | Concord, NC 28025-3699 |
Second Address | Concord, NC 28025-3699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11661990 | CAQH (01) | |
78018256 | (05) | KY |
Q77532 | (02) | KY |