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General NPI Number Information
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NPI Number | 1013468784
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Entity Type | Organization
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Legal Business Name | JARVIS FAMILY MEDICAL SERVICES
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 8134 NEW LA GRANGE RD STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40222-4677
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Country | US
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Telephone | 502-822-3659
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Fax | 502-709-4637
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Provider Business Mailing Address
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Address Line | 8134 NEW LA GRANGE RD STE 100
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City | LOUISVILLE
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State | KY
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Zip | 40222-4677
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Country | US
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Telephone | 502-822-3659
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Fax | 502-709-4637
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | RENEE WHITING
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Credential | CPC, CPC-I
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Telephone | 859-539-2466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007742
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License Number State | KY
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