Healthcare Provider Details

I. General information

NPI: 1922685858
Provider Name (Legal Business Name): JONATHAN SCOTT MERSEREAU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-1066
US

IV. Provider business mailing address

870 FRANKLIN RD APT G6
LEBANON OH
45036-4110
US

V. Phone/Fax

Practice location:
  • Phone: 567-825-4723
  • Fax: 513-705-4706
Mailing address:
  • Phone: 567-825-4723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4045069
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0029281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: