Provider Demographics
NPI:1235501305
Name:NEIGHBORS, JESSE LEE
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LEE
Last Name:NEIGHBORS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:FRANKLIN
Other - Last Name:NEIGHBORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 N ROGERS ST
Mailing Address - Street 2:104 N ROGERS ST
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1834
Mailing Address - Country:US
Mailing Address - Phone:740-326-9161
Mailing Address - Fax:
Practice Address - Street 1:104 N ROGERS ST
Practice Address - Street 2:104 N ROGERS ST
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1834
Practice Address - Country:US
Practice Address - Phone:740-326-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246Z00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1235501305Medicaid
OH363LF0000XMedicaid
OH363LF0000XMedicaid