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General NPI Number Information
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NPI Number | 1821897695
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Entity Type | Organization
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Legal Business Name | JEREMIA 17:14 FAMILY MEDICINE
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Dates
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Enumeration Date | 03/12/2025
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 301 BURKESVILLE ST
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City | COLUMBIA
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State | KY
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Zip | 42728-1921
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Country | US
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Telephone | 270-384-9934
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Fax |
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Provider Business Mailing Address
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Address Line | 293 SHAGBARK RD
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City | NEW HAVEN
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State | KY
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Zip | 40051-6134
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Country | US
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Telephone | 270-995-9624
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Fax | 270-995-9624
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | TERESA A PERKINS
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Credential | APRN
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Telephone | 270-995-9624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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