Healthcare Provider Details

I. General information

NPI: 1992632517
Provider Name (Legal Business Name): VICEY ANN COMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HIGHWAY 15 S STE 240
JACKSON KY
41339-0709
US

IV. Provider business mailing address

1550 HIGHWAY 15 S STE 240
JACKSON KY
41339-0709
US

V. Phone/Fax

Practice location:
  • Phone: 606-824-5037
  • Fax: 606-824-5042
Mailing address:
  • Phone: 606-824-5037
  • Fax: 606-824-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4021809
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: