Provider Demographics
NPI:1417749136
Name:LUCAS, JESSICA LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:LUCAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 GRAND OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-8685
Mailing Address - Country:US
Mailing Address - Phone:502-439-9185
Mailing Address - Fax:
Practice Address - Street 1:371 GRAND OAK BLVD
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8685
Practice Address - Country:US
Practice Address - Phone:502-439-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2025029813363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health