Healthcare Provider Details

I. General information

NPI: 1497618797
Provider Name (Legal Business Name): JENNIE STUART MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10755 EAGLE WAY STE 100
HOPKINSVILLE KY
42240-8742
US

IV. Provider business mailing address

PO BOX 2400
HOPKINSVILLE KY
42241-2400
US

V. Phone/Fax

Practice location:
  • Phone: 270-887-0100
  • Fax:
Mailing address:
  • Phone: 270-887-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AUTUMN BAILEY
Title or Position: DIRECTOR
Credential:
Phone: 270-887-0100