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NPI Code Detail

MEDICARE: JERRY KUNKEL APRN

MEDICARE: JERRY KUNKEL APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner3011462KY

General Provider Information

NPI Number : 1548781164
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY KUNKEL APRN
Provider Business Mailing Address
First Line : 803 MEYERS BAKER RD STE 200
Second Line :
City : LONDON
State : KY
Zip : 40741-3040
Country : US
Telephone Number : 606-878-3240
Fax Number :
Provider Business Practice Location Address
First Line : 803 MEYERS BAKER RD STE 200
Second Line :
City : LONDON
State : KY
Zip : 40741-3040
Country : US
Telephone Number : 606-878-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2017
Last Update Date : 07/21/2022

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