Individual
MRS. JACQUELINE M THIRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
218 S. MAPLE ST., WINCHESTER, KY 40391
(859) 745-2861
(859) 745-1978
Mailing address
218 S. MAPLE STREET, WINCHESTER, KY 40391
(859) 745-2861
(859) 745-1978
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2717
KY
363A00000X
Physician Assistant
PA9111189
FL
363AM0700X
Medical Physician Assistant
PA2717
KY
363AS0400X
Surgical Physician Assistant
PA2717
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100738410
—
KY
Enumeration date
12/20/2017
Last updated
11/22/2021
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