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General NPI Number Information
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NPI Number | 1346261013
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Entity Type | Individual
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Provider Name | JESSICA B ICE PA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 107 PERRY ST
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City | BLOOMFIELD
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State | KY
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Zip | 40008
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Country | US
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Telephone | 502-252-5081
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Fax | 502-252-7211
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Provider Business Mailing Address
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Address Line | PO BOX 400
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City | BLOOMFIELD
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State | KY
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Zip | 40008
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Country | US
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Telephone | 502-252-5081
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Fax | 502-252-7211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 918
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License Number State | KY
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