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General NPI Number Information
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NPI Number | 1619283454
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Entity Type | Organization
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Legal Business Name | JW MEDICAL, L.L.C.
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 889 CLARKS LN
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City | LOUISVILLE
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State | KY
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Zip | 40217-2437
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Country | US
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Telephone | 502-386-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 889 CLARKS LN
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City | LOUISVILLE
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State | KY
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Zip | 40217-2437
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Country | US
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Telephone | 502-386-9390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACOB WILLIAM HARVEY JR.
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Credential | F.N.P.
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Telephone | 502-386-9390
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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 | 6597
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License Number State | KY
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