Healthcare Provider Details

I. General information

NPI: 1588339600
Provider Name (Legal Business Name): JACKIE ADINGTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W PLEASANT POINT SCHOOL RD
WAYNESBURG KY
40489-9621
US

IV. Provider business mailing address

42 W PLEASANT POINT SCHOOL RD
WAYNESBURG KY
40489-9621
US

V. Phone/Fax

Practice location:
  • Phone: 606-510-4040
  • Fax:
Mailing address:
  • Phone: 606-510-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016481
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: