Healthcare Provider Details

I. General information

NPI: 1407818628
Provider Name (Legal Business Name): JUNIPER HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 GRAND AVENUE
BEATTYVILLE KY
41311-9249
US

IV. Provider business mailing address

PO BOX 690
BEATTYVILLE KY
41311-0690
US

V. Phone/Fax

Practice location:
  • Phone: 606-464-2401
  • Fax: 606-464-3290
Mailing address:
  • Phone: 606-464-0151
  • Fax: 606-464-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number700132
License Number StateKY

VIII. Authorized Official

Name: DERRICK J HAMILTON
Title or Position: CEO
Credential: DO, CEO, CMO
Phone: 606-666-9950