Healthcare Provider Details

I. General information

NPI: 1073643599
Provider Name (Legal Business Name): JESSAMINE CHRISTIAN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RICE ST
WILMORE KY
40390-1359
US

IV. Provider business mailing address

200 RICE ST
WILMORE KY
40390-1359
US

V. Phone/Fax

Practice location:
  • Phone: 859-858-9355
  • Fax: 859-858-0416
Mailing address:
  • Phone: 859-858-9355
  • Fax: 859-858-0416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31991
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34906
License Number StateKY

VIII. Authorized Official

Name: MR. LARRY DAVID WILLIAMS
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 859-858-9355