Provider Demographics
NPI:1619402450
Name:LEMON, JARED MICHAEL
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:LEMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PROSPEROUS PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1898
Mailing Address - Country:US
Mailing Address - Phone:859-368-0609
Mailing Address - Fax:
Practice Address - Street 1:161 PROSPEROUS PL
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1898
Practice Address - Country:US
Practice Address - Phone:859-368-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011456363LP0808X
OH0028202363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health