Provider Demographics
NPI:1679139844
Name:VANCE, JESSE MICHAEL (MD, PHARMD, MBA)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:MICHAEL
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD, PHARMD, MBA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:245 FLEMINGSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1015
Mailing Address - Country:US
Mailing Address - Phone:606-780-5500
Mailing Address - Fax:606-780-2373
Practice Address - Street 1:245 FLEMINGSBURG RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1015
Practice Address - Country:US
Practice Address - Phone:606-780-5500
Practice Address - Fax:606-780-2373
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69688207R00000X
MN30911207R00000X
KY61041207R00000X
KY015939183500000X
TX49366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No183500000XPharmacy Service ProvidersPharmacist