Healthcare Provider Details

I. General information

NPI: 1275354581
Provider Name (Legal Business Name): MARKETA JANSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARKETA JANSON

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLINIC DR
MADISONVILLE KY
42431-1661
US

IV. Provider business mailing address

157 IRON MOUNTAIN RD E
HARTFORD KY
42347-9651
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-1000
  • Fax:
Mailing address:
  • Phone: 270-363-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3018941
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3018941
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: