Provider Demographics
NPI:1518922129
Name:LEMON, JASON R (PA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:LEMON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9880 ANGIES WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2851
Practice Address - Country:US
Practice Address - Phone:502-394-6340
Practice Address - Fax:502-394-6340
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2446855000OtherPASSPORT ADVANTAGE / NCMA
KY00000327353OtherANTHEM / NCMA
KY040479OtherSIHO / NCMA
KY50005551OtherPASSPORT / NCMA
KY000028412GOtherHUMANA / NCMA
KY1205913OtherCHA / NCMA
KY95003331Medicaid
KY50005551OtherPASSPORT / NCMA
KY95003331Medicaid
KY1205913OtherCHA / NCMA