Healthcare Provider Details

I. General information

NPI: 1073648267
Provider Name (Legal Business Name): JESSAMINE COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 WILMORE RD
NICHOLASVILLE KY
40356-9462
US

IV. Provider business mailing address

871 WILMORE ROAD
NICHOLASVILL KY
40356
US

V. Phone/Fax

Practice location:
  • Phone: 859-885-4179
  • Fax: 859-881-5649
Mailing address:
  • Phone: 859-885-4179
  • Fax: 859-881-5649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number2105701300
License Number StateKY

VIII. Authorized Official

Name: MR. MATHEW MOORE
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 859-885-4179