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NPI Code Detail

MEDICARE: MRS. ANGELA M JESSIE APRN

MEDICARE: MRS. ANGELA M JESSIE APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner3003026KY
2363LF0000XFamily Nurse Practitioner3003026KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111386204OTHERKYCAQH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720050818
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA M JESSIE APRN
Provider Business Mailing Address
First Line : PO BOX 1080
Second Line :
City : BURKESVILLE
State : KY
Zip : 42717-1080
Country : US
Telephone Number : 270-858-6655
Fax Number : 270-858-4027
Provider Business Practice Location Address
First Line : 109 SARTIN DR
Second Line :
City : EDMONTON
State : KY
Zip : 42129-8170
Country : US
Telephone Number : 270-432-2444
Fax Number : 270-432-2445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2006
Last Update Date : 06/20/2024

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