Provider Demographics
NPI:1700344934
Name:NIEMEYER, JESSA MARIE (PMHNP)
Entity type:Individual
Prefix:MS
First Name:JESSA
Middle Name:MARIE
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CHESTNUT PARK
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-2357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3615 SOCIALVILLE FOSTER RD STE C
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9054
Practice Address - Country:US
Practice Address - Phone:513-209-1910
Practice Address - Fax:513-204-0049
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN284477163WP0200X
OHAPRN.CNP.0027725363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics