Provider Demographics
NPI:1598256612
Name:JEMISON, MEESHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MEESHA
Middle Name:
Last Name:JEMISON
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ALBANY TPKE # 1014
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2903
Mailing Address - Country:US
Mailing Address - Phone:860-866-3086
Mailing Address - Fax:
Practice Address - Street 1:15 ALBANY TPKE # 1014
Practice Address - Street 2:
Practice Address - City:WEST SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06092-2903
Practice Address - Country:US
Practice Address - Phone:860-866-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8079363LP0808X
CT096899163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse