MEDICARE: JESSICA MARIE STITH MSN, APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3017917	KY

General Provider Information

NPI Number	:	1427788413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE STITH MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1031 NEW MOODY LN STE 300
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-9178
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 NEW MOODY LN STE 300
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-9178
Country	:	US
Telephone Number	:	502-222-6008
Fax Number	:	502-225-9878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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