Provider Demographics
NPI:1992700108
Name:JAGER, SHAWN M (ARNP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:JAGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 THOMAS MORE PKWY
Mailing Address - Street 2:STE 260
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5100
Mailing Address - Country:US
Mailing Address - Phone:859-957-0700
Mailing Address - Fax:859-957-0703
Practice Address - Street 1:340 THOMAS MORE PKWY
Practice Address - Street 2:STE 260
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5100
Practice Address - Country:US
Practice Address - Phone:859-957-0700
Practice Address - Fax:859-957-0703
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3513P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006566Medicaid
P43030Medicare UPIN
KY0666703Medicare ID - Type Unspecified