Healthcare Provider Details

I. General information

NPI: 1215470224
Provider Name (Legal Business Name): JOURNEYPURE KENTUCKY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3986
US

IV. Provider business mailing address

5080 FLORENCE RD
MURFREESBORO TN
37129-2922
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-3387
  • Fax:
Mailing address:
  • Phone: 615-907-5037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE BOWERS
Title or Position: DIRECTOR OF OP RCM
Credential:
Phone: 615-715-4214