Healthcare Provider Details

I. General information

NPI: 1023153152
Provider Name (Legal Business Name): KATHRYN SUSAN JASPER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 S HIGHWAY 27
STEARNS KY
42647-6297
US

IV. Provider business mailing address

PO BOX 28
STEARNS KY
42647-0028
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-9700
  • Fax: 606-376-9703
Mailing address:
  • Phone: 606-376-9700
  • Fax: 606-376-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002568
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: