=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629720180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JESSICA ANGLIN NP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2022
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5137 STATE ROUTE 56 E
-----------------------------------------------------
City | SEBREE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42455-9144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-635-6360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5137 STATE ROUTE 56 E
-----------------------------------------------------
City | SEBREE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42455-9144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-635-6360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | JESSICA LYNN ANGLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-635-6360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------