MEDICARE: JENNIE STUART MEDICAL CENTER INC

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	363LX0106X	Occupational Health Nurse Practitioner

General Provider Information

NPI Number	:	1497618797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIE STUART MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 2400
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42241-2400
Country	:	US
Telephone Number	:	270-887-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	10755 EAGLE WAY STE 100
Second Line	:
City	:	HOPKINSVILLE
State	:	KY
Zip	:	42240-8742
Country	:	US
Telephone Number	:	270-887-0100
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	AUTUMN BAILEY
Credential	:
Telephone Number	:	270-887-0100

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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