Healthcare Provider Details

I. General information

NPI: 1700344934
Provider Name (Legal Business Name): JESSA MARIE NIEMEYER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 SOCIALVILLE FOSTER RD STE C
MASON OH
45040-9054
US

IV. Provider business mailing address

3701 CHESTNUT PARK
CLEVES OH
45002-2357
US

V. Phone/Fax

Practice location:
  • Phone: 513-209-1910
  • Fax: 513-204-0049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0027725
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN284477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: