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General NPI Number Information
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NPI Number | 1134617285
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Entity Type | Individual
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Provider Name | PETER JAGER APRN
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Gender | Male
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 08/18/2018
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Provider Practice Location Address
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Address Line | 1 MEDICAL VILLAGE DR
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City | EDGEWOOD
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State | KY
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Zip | 41017
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Country | US
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Telephone | 859-301-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 6220 LOWER TUG FORK RD
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City | MELBOURNE
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State | KY
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Zip | 41059-8266
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Country | US
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Telephone | 859-750-7323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3011367
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3011367
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License Number State | KY
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