Basic Information
| Provider Information | |||||||||
| NPI: | 1518970961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGG | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | APRN, DNP, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | ST. ELIZABETH PHYSICIANS | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593015901 | ||||||||
| FaxNumber: | 8593015940 | ||||||||
| Practice Location | |||||||||
| Address1: | 512 MAPLE AVE | ||||||||
| Address2: | ST ELIZABETH FALMOUTH | ||||||||
| City: | FALMOUTH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595723500 | ||||||||
| FaxNumber: | 8596544323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3003252 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | 3003252 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363L00000X | 3003252 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 78012002 | 05 | KY | MEDICAID | 3012233 | 05 | OH | MEDICAID | 000000385272 | 01 | KY | ANTHEM | OTHER |