Individual
JACKELYN N. BLUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1760 NICHOLASVILLE RD, SUITE 603, LEXINGTON, KY 40503-1471
(859) 277-2211
(859) 277-7575
Mailing address
1760 NICHOLASVILLE RD, SUITE 603, LEXINGTON, KY 40503-1471
(859) 277-2211
(859) 277-7575
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA247
KY
363AM0700X
Medical Physician Assistant
PA247
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95002473
—
KY
01
—
970020899
RR MEDICARE
KY
Enumeration date
10/04/2006
Last updated
12/10/2020
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