Individual
JASMAINE THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2601 KENTUCKY AVE, SUITE 103, PADUCAH, KY 42003-3817
(270) 415-4860
(270) 415-4862
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 253-4900
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3009523
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100390020
—
KS
Enumeration date
07/14/2015
Last updated
12/03/2019
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