MEDICARE: JARED MICHAEL LEMON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	3011456	KY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0028202	OH

General Provider Information

NPI Number	:	1619402450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED MICHAEL LEMON

Provider Business Mailing Address
First Line	:	161 PROSPEROUS PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1898
Country	:	US
Telephone Number	:	859-368-0609
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 PROSPEROUS PL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1898
Country	:	US
Telephone Number	:	859-368-0609
Fax Number	:

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

Provider Enumeration Date	:	05/01/2017
Last Update Date	:	03/24/2022

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