Basic Information
| Provider Information | |||||||||
| NPI: | 1477225985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEMERA | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | NICOLAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8233 E STOCKTON BLVD STE D | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958288203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167375555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8233 E STOCKTON BLVD D | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167375555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95018642 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.