MEDICARE: JASON LUNSFORD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3009686	KY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3009686	KY
3	363LF0000X	Family Nurse Practitioner	3009686	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093183600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON LUNSFORD APRN

Provider Business Mailing Address
First Line	:	496 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1827
Country	:	US
Telephone Number	:	859-288-2392
Fax Number	:	859-288-7510

Provider Business Practice Location Address
First Line	:	1060 GOODWIN DR STE 110
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-3824
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-288-7510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	08/02/2024

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