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General NPI Number Information
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NPI Number | 1700989258
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Entity Type | Individual
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Provider Name | JACKIE C. NOLAND ARNP
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Gender | Female
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 206 S MAIN ST
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City | CORBIN
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State | KY
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Zip | 40701-1456
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Country | US
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Telephone | 606-528-0283
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Fax | 606-528-8422
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Provider Business Mailing Address
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Address Line | 6387 US 150 E
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City | STANFORD
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State | KY
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Zip | 40484
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Country | US
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Telephone | 859-749-0561
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4355P
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License Number State | KY
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