Healthcare Provider Details

I. General information

NPI: 1295257517
Provider Name (Legal Business Name): JESSI DIANA LLOYD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 CRUME RD
VINE GROVE KY
40175-1130
US

IV. Provider business mailing address

423 CRUME RD
VINE GROVE KY
40175-1130
US

V. Phone/Fax

Practice location:
  • Phone: 270-900-1236
  • Fax: 270-506-3913
Mailing address:
  • Phone: 270-900-1236
  • Fax: 270-506-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06172322
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: