Healthcare Provider Details

I. General information

NPI: 1033040597
Provider Name (Legal Business Name): JACQUELYNE ANNE FRIEBIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

IV. Provider business mailing address

1 TRILLIUM WAY
CORBIN KY
40701-8426
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-1212
  • Fax: 606-528-8661
Mailing address:
  • Phone: 606-528-1212
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: