Organization
KENTUCKY MEDICAL SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY BRACKETT M.D. (PRESIDENT)
(606) 788-1035
Entity
Organization
Contact information
Practice address
636 JEFFERSON AVE, PAINTSVILLE, KY 41240-1349
(606) 788-1035
(606) 788-1045
Mailing address
PO BOX 2710, PAINTSVILLE, KY 41240-6710
(606) 788-1035
(606) 788-1045
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
14390
KY
Other
Enumeration date
09/17/2014
Last updated
09/17/2014
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