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General NPI Number Information
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NPI Number | 1992254288
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Entity Type | Organization
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Legal Business Name | JACKSON PURCHASE PULMONARY MEDICINE PLLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1111 MEDICAL CENTER CIR
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City | MAYFIELD
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State | KY
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Zip | 42066-1194
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Country | US
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Telephone | 270-251-4040
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Fax | 855-430-0335
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Provider Business Mailing Address
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Address Line | 1111 MEDICAL CENTER CIR
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City | MAYFIELD
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State | KY
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Zip | 42066-1194
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Country | US
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Telephone | 270-251-4040
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Fax | 855-430-0335
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. TAMMY D MCCARY
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Credential |
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Telephone | 270-251-4040
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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 | 3010022
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License Number State | KY
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