Healthcare Provider Details

I. General information

NPI: 1598256612
Provider Name (Legal Business Name): MEESHA JEMISON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ALBANY TPKE # 1014
WEST SIMSBURY CT
06092-2903
US

IV. Provider business mailing address

15 ALBANY TPKE # 1014
WEST SIMSBURY CT
06092-2903
US

V. Phone/Fax

Practice location:
  • Phone: 860-866-3086
  • Fax: 507-416-7490
Mailing address:
  • Phone: 860-866-3086
  • Fax: 507-416-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number096899
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8079
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: