Healthcare Provider Details

I. General information

NPI: 1245700442
Provider Name (Legal Business Name): JESSICA NICOLE HUFF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HIGHWAY 44 E
SHEPHERDSVILLE KY
40165-6002
US

IV. Provider business mailing address

PO BOX 6540
SHEPHERDSVILLE KY
40165-6540
US

V. Phone/Fax

Practice location:
  • Phone: 502-215-8422
  • Fax: 502-215-8373
Mailing address:
  • Phone: 502-419-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012947
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1139292
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: