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General NPI Number Information
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NPI Number | 1073643599
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Entity Type | Organization
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Legal Business Name | JESSAMINE CHRISTIAN HEALTHCARE, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 200 RICE ST
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City | WILMORE
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State | KY
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Zip | 40390-1359
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Country | US
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Telephone | 859-858-9355
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Fax | 859-858-0416
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Provider Business Mailing Address
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Address Line | 200 RICE ST
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City | WILMORE
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State | KY
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Zip | 40390-1359
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Country | US
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Telephone | 859-858-9355
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Fax | 859-858-0416
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | MR. LARRY DAVID WILLIAMS
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Credential |
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Telephone | 859-858-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31991
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34906
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License Number State | KY
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