Healthcare Provider Details

I. General information

NPI: 1477569226
Provider Name (Legal Business Name): AARON K. JONAN MEMORIAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 HIGHWAY 15 N
JACKSON KY
41339-8284
US

IV. Provider business mailing address

832 HIGHWAY 15 N
JACKSON KY
41339-8284
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-5142
  • Fax: 606-666-4172
Mailing address:
  • Phone: 606-666-5142
  • Fax: 606-666-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43629
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006826
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number900029
License Number StateKY

VIII. Authorized Official

Name: DJIEN SO
Title or Position: ADMINISTRATOR/ACCESS MANAGER
Credential:
Phone: 606-794-5600