Provider Demographics
NPI:1053397521
Name:APPLEBERRY, JASON (PA-C, MPAS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:APPLEBERRY
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 PARKVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4804
Mailing Address - Country:US
Mailing Address - Phone:206-201-3880
Mailing Address - Fax:
Practice Address - Street 1:1519 ALASKAN WAY SOUTH
Practice Address - Street 2:USCG ISC SEATTLE HEALTH SERVICES
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134
Practice Address - Country:US
Practice Address - Phone:206-217-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1054309OtherNCCPA CERTIFICATE NUMBER