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Individual
JEREMY BOCKELMAN
Active
Individual
JEREMY BOCKELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3008922
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000893307
ANTHEM-NMA
KY
01
—
165891
SIHO-NMA
KY
01
—
50076921
PASSPORT-NMA
KY
05
—
7100330320
—
KY
Enumeration date
09/11/2014
Last updated
04/15/2015
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