Individual
JACOB LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1919 CORNISHVILLE RD, HARRODSBURG, KY 40330-9404
(859) 612-7454
Mailing address
1919 CORNISHVILLE RD, HARRODSBURG, KY 40330-9404
(859) 612-7454
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1154594
KY
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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