Provider Demographics
NPI:1205403508
Name:JERPSETH, LEA S (NP-C)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:S
Last Name:JERPSETH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 W 13TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4271
Mailing Address - Country:US
Mailing Address - Phone:192-830-4538
Mailing Address - Fax:
Practice Address - Street 1:1950 W 3RD ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1812
Practice Address - Country:US
Practice Address - Phone:928-276-4477
Practice Address - Fax:928-276-4481
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260049363LF0000X
AZRN089048163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ261220OtherMEDICARE
AZ098404Medicaid