Healthcare Provider Details

I. General information

NPI: 1083483747
Provider Name (Legal Business Name): JENNIFER LOUISE SALYERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 BELLEFONTE RD
FLATWOODS KY
41139-2503
US

IV. Provider business mailing address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

V. Phone/Fax

Practice location:
  • Phone: 606-834-0125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4014017
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: