Individual
MR. JERRY WAYNE IERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
142 DEPOT DR, SOUTH SHORE, KY 41175
(606) 932-2271
(606) 932-2273
Mailing address
PO BOX 550, VANCEBURG, KY 41179
(606) 796-3029
(606) 796-6221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA983
KY
363AM0700X
Medical Physician Assistant
1074488
OH
363AM0700X
Medical Physician Assistant
Primary
PA983
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1074488
NCCPA
—
05
—
7100017560
—
KY
05
—
7100373870
—
KY
Enumeration date
10/26/2006
Last updated
04/18/2017
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