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General NPI Number Information
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NPI Number | 1417770207
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Entity Type | Organization
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Legal Business Name | KJ HEALTH SERVICES LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1 MAIN ST STE 201
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City | EVANSVILLE
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State | IN
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Zip | 47708-1473
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Country | US
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Telephone | 812-202-6842
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MAIN ST STE 201
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City | EVANSVILLE
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State | IN
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Zip | 47708-1473
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Country | US
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Telephone | 812-202-6842
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | KIMBERLY A JACKSON
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Credential | APRN
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Telephone | 812-455-1671
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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 |
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License Number State |
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