Provider Demographics
NPI:1194426452
Name:LEMON, KREGG ANDREW (PA-C)
Entity type:Individual
Prefix:
First Name:KREGG
Middle Name:ANDREW
Last Name:LEMON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-854-6769
Practice Address - Street 1:3161 L ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5234
Practice Address - Country:US
Practice Address - Phone:916-878-3495
Practice Address - Fax:916-736-5533
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2025-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1206358363A00000X
NV1206358363A00000X
CAPA65689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant