Healthcare Provider Details

I. General information

NPI: 1710718218
Provider Name (Legal Business Name): JUSTIN MESSER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7510
  • Fax:
Mailing address:
  • Phone: 606-487-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4028496
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1166592
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: