Provider Demographics
NPI:1225516644
Name:HARPER, JARED MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MATTHEW
Last Name:HARPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WILSON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1947
Mailing Address - Country:US
Mailing Address - Phone:859-879-0111
Mailing Address - Fax:
Practice Address - Street 1:460 WILSON AVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1947
Practice Address - Country:US
Practice Address - Phone:859-879-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical