Individual
JESSICA WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
466 BURNLEY RD, SCOTTSVILLE, KY 42164-6355
(270) 618-3700
Mailing address
466 BURNLEY RD, SCOTTSVILLE, KY 42164-6355
(270) 618-3700
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
1137080
KY
363LF0000X
Family Nurse Practitioner
Primary
3016353
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1137080
RN LICENSE
KY
05
—
3016353
—
KY
Enumeration date
05/08/2020
Last updated
12/28/2022
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