Individual
MRS. MIRANDA JO JEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
301 PROFESSIONAL PARK DR, GLASGOW, KY 42141-3487
(270) 651-9696
(270) 651-0385
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6644
(270) 858-4027
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
3011720
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3011720
KENTUCKY MEDICAL LICENSE
KY
Enumeration date
09/17/2017
Last updated
07/21/2022
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