Healthcare Provider Details

I. General information

NPI: 1891133831
Provider Name (Legal Business Name): JESSICA MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST
OWENSBORO KY
42301-2956
US

IV. Provider business mailing address

PO BOX 1637
OWENSBORO KY
42302-1637
US

V. Phone/Fax

Practice location:
  • Phone: 270-689-6500
  • Fax:
Mailing address:
  • Phone: 270-689-6500
  • Fax: 270-689-6677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001337
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09928535
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: