Provider Demographics
NPI:1225516644
Name:HARPER, JARED MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MATTHEW
Last Name:HARPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 WAR ADMIRAL WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2546
Mailing Address - Country:US
Mailing Address - Phone:859-554-8486
Mailing Address - Fax:859-368-8920
Practice Address - Street 1:460 WILSON AVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1947
Practice Address - Country:US
Practice Address - Phone:859-879-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2401363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical