Provider Demographics
NPI:1063839504
Name:LEMP, MICHAEL KEVIN (MSN, APN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:LEMP
Suffix:
Gender:M
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:19 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:PONTOON BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6703
Mailing Address - Country:US
Mailing Address - Phone:618-741-4563
Mailing Address - Fax:
Practice Address - Street 1:2893 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3526
Practice Address - Country:US
Practice Address - Phone:618-255-8174
Practice Address - Fax:636-639-2368
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011397363LF0000X
MO2014022531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400150872Medicare PIN