Healthcare Provider Details

I. General information

NPI: 1972881324
Provider Name (Legal Business Name): J. R. HOLDINGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 BARRETT BLVD
HENDERSON KY
42420-2620
US

IV. Provider business mailing address

612 BARRETT BLVD
HENDERSON KY
42420-2620
US

V. Phone/Fax

Practice location:
  • Phone: 270-844-8232
  • Fax: 270-844-8238
Mailing address:
  • Phone: 270-844-8232
  • Fax: 270-844-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JENNIFER TODD
Title or Position: OFFICE MANAGER/OWNER
Credential:
Phone: 270-844-8232