Provider Demographics
NPI:1124423801
Name:JASPERSEN, MEGAN M (MS)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:M
Last Name:JASPERSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BIG SINK RD STE B
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1956
Mailing Address - Country:US
Mailing Address - Phone:859-873-7316
Mailing Address - Fax:859-873-7669
Practice Address - Street 1:125 BIG SINK RD STE B
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1956
Practice Address - Country:US
Practice Address - Phone:859-873-7316
Practice Address - Fax:859-873-7669
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid