Individual
MR. JASON KENDALL WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
310 NORTH STATE AND FRANKLIN ROAD, STE 103, JOHNSON CITY, TN 37604-6063
(423) 232-8301
(423) 232-8304
Mailing address
PO BOX 4673, JOHNSON CITY, TN 37602-4673
(423) 232-8301
(423) 232-8304
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
820
TN
363AM0700X
Medical Physician Assistant
Primary
PA0000000820
TN
363AS0400X
Surgical Physician Assistant
PA0000000820
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3661736
—
TN
Enumeration date
06/01/2006
Last updated
03/16/2011
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