Provider Demographics
NPI:1518970961
Name:GREGG, JASON A (APRN, DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:GREGG
Suffix:
Gender:M
Credentials:APRN, DNP, PMHNP-BC
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 635283
Mailing Address - Street 2:ST. ELIZABETH PHYSICIANS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-5901
Mailing Address - Fax:859-301-5940
Practice Address - Street 1:512 MAPLE AVE
Practice Address - Street 2:ST ELIZABETH FALMOUTH
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040
Practice Address - Country:US
Practice Address - Phone:859-572-3500
Practice Address - Fax:859-654-4323
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003252363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3012233Medicaid
KY78012002Medicaid
KY000000385272OtherANTHEM
KY927127Medicare PIN
OH3012233Medicaid
KY00954031Medicare PIN