Healthcare Provider Details

I. General information

NPI: 1841700689
Provider Name (Legal Business Name): YOUR CARE MOBILE HEALTH PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6387 US HIGHWAY 150 E
STANFORD KY
40484-9748
US

IV. Provider business mailing address

6387 US HIGHWAY 150 E
STANFORD KY
40484-9748
US

V. Phone/Fax

Practice location:
  • Phone: 606-669-1542
  • Fax:
Mailing address:
  • Phone: 606-669-1542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACKIE NOLAND
Title or Position: OWNER/PROVIDER
Credential: ARNP
Phone: 606-669-1542