MEDICARE: DR. JESSE LEE NEIGHBORS

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	246Z00000X	Other Specialist/Technologist		OH
2	363LF0000X	Family Nurse Practitioner		OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235501305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE LEE NEIGHBORS

Provider Business Mailing Address
First Line	:	104 N ROGERS ST
Second Line	:	104 N ROGERS ST
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1834
Country	:	US
Telephone Number	:	740-326-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 N ROGERS ST
Second Line	:	104 N ROGERS ST
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1834
Country	:	US
Telephone Number	:	740-326-9161
Fax Number	:

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

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	07/21/2022

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