Healthcare Provider Details

I. General information

NPI: 1407924806
Provider Name (Legal Business Name): MACLIMORE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE BLDG C STE 104
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

4551 SPRINGHILL DR STE 3
OWENSBORO KY
42303-4672
US

V. Phone/Fax

Practice location:
  • Phone: 270-852-1632
  • Fax: 270-852-1633
Mailing address:
  • Phone: 270-852-1632
  • Fax: 270-852-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17376
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 340
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 334
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON L ABNEY
Title or Position: OFFICE MANAGER
Credential: RT(R)
Phone: 270-852-1632