Individual
VANESSA LEE JACO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
37 BALL PARK RD, HARLAN, KY 40831-1701
(606) 573-4520
Mailing address
37 BALL PARK RD, HARLAN, KY 40831-1701
(606) 573-4520
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
1-087710
AL
363LA2100X
Acute Care Nurse Practitioner
Primary
4010950
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051553292
—
AL
05
—
112804
—
AL
05
—
112805
—
AL
05
—
112806
—
AL
05
—
112809
—
AL
05
—
112813
—
AL
05
—
112815
—
AL
01
—
510-49321
BCBS
AL
01
—
510-49322
BCBS
AL
01
—
510-49323
BCBS
AL
01
—
510-49324
BCBS
AL
01
—
510-49443
BCBS
AL
01
—
515-98704
BCBS
AL
01
—
51515966
BCBS
AL
01
—
P00015330
RAILROAD MEDICARE
AL
Enumeration date
04/04/2007
Last updated
11/21/2023
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