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NPI Code Detail

MEDICARE: AARON K. JONAN MEMORIAL CLINIC INC.

MEDICARE: AARON K. JONAN MEMORIAL CLINIC INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician43629KY
2363LF0000XFamily Nurse Practitioner3006826KY
3261QR1300XRural Health Clinic/Center900029KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477569226
Entity Type Code : Organization
Provider Name (Legal Business Name) : AARON K. JONAN MEMORIAL CLINIC INC.
Provider Business Mailing Address
First Line : 832 HIGHWAY 15 N
Second Line :
City : JACKSON
State : KY
Zip : 41339-8284
Country : US
Telephone Number : 606-666-5142
Fax Number : 606-666-4172
Provider Business Practice Location Address
First Line : 832 HIGHWAY 15 N
Second Line :
City : JACKSON
State : KY
Zip : 41339-8284
Country : US
Telephone Number : 606-666-5142
Fax Number : 606-666-4172
Authorized Official
Title or Position : ADMINISTRATOR/ACCESS MANAGER
Name : DJIEN SO
Credential :
Telephone Number : 606-794-5600
Provider Enumeration Date : 08/01/2006
Last Update Date : 05/09/2023

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