Provider Demographics
NPI:1245581578
Name:LEVERING, JOLEEN NYESA
Entity Type:Individual
Prefix:DR
First Name:JOLEEN
Middle Name:NYESA
Last Name:LEVERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 WALLINGFORD CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4332
Mailing Address - Country:US
Mailing Address - Phone:606-875-4391
Mailing Address - Fax:
Practice Address - Street 1:1078 NORTH MAIN STREEET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633
Practice Address - Country:US
Practice Address - Phone:606-348-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist