Provider Demographics
NPI:1780985895
Name:JEZ, MEGHAN LANE (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LANE
Last Name:JEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:LANE
Other - Last Name:KAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2913 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2017
Mailing Address - Country:US
Mailing Address - Phone:513-305-5126
Mailing Address - Fax:
Practice Address - Street 1:7794 5 MILE RD STE 240
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-2372
Practice Address - Country:US
Practice Address - Phone:513-231-1575
Practice Address - Fax:855-818-3918
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003163363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical