Individual
MR. JASON ENGHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
(270) 798-8224
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
(270) 798-8224
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
168920
TN
363L00000X
Nurse Practitioner
Primary
24887
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168920
RN LISCENSE
TN
01
—
24887
APRN LICENSE
TN
Enumeration date
09/03/2018
Last updated
04/03/2024
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