MEDICARE: JOANNE COMBS

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
1	363L00000X	Nurse Practitioner	3010564	KY

General Provider Information

NPI Number	:	1932652096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE COMBS

Provider Business Mailing Address
First Line	:	200 MULBERRY ST STE A
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MULBERRY ST STE A
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2016
Last Update Date	:	07/25/2016

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Directions to “ JOANNE COMBS ” Practice Location

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