Healthcare Provider Details

I. General information

NPI: 1568457398
Provider Name (Legal Business Name): JENNIE KAYE BOURNE MSN, RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 8TH ST STE 401E
MURRAY KY
42071
US

IV. Provider business mailing address

300 S 8TH ST STE 401E
MURRAY KY
42071-2444
US

V. Phone/Fax

Practice location:
  • Phone: 270-753-2444
  • Fax: 270-752-2865
Mailing address:
  • Phone: 270-753-2444
  • Fax: 270-767-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3005174
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: