Healthcare Provider Details

I. General information

NPI: 1801479985
Provider Name (Legal Business Name): JESSICA PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LINVILLE DR STE 100
PARIS KY
40361-2165
US

IV. Provider business mailing address

126 GREYSTONE CT
PARIS KY
40361-6000
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-3388
  • Fax:
Mailing address:
  • Phone: 859-707-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015151
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: