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General NPI Number Information
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NPI Number | 1992436166
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Entity Type | Individual
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Provider Name | JERRICA DUTY APRN
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Gender | Female
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 540 JETT DR
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City | JACKSON
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State | KY
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Zip | 41339-9622
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Country | US
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Telephone | 606-666-6137
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Fax |
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Provider Business Mailing Address
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Address Line | 256 PINE HILL DR
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City | JACKSON
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State | KY
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Zip | 41339-9682
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Country | US
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Telephone | 606-548-0745
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3017938
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License Number State | KY
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