Organization
EASLER & WHITE MEDIVERSAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKQUELINE EASLER APRN (OWNER/MEMBER)
(270) 903-3168
Entity
Organization
Contact information
Practice address
922 TRIPLETT ST STE 7, OWENSBORO, KY 42303-3118
(270) 903-3168
Mailing address
922 TRIPLETT ST STE 7, OWENSBORO, KY 42303-3118
(270) 903-3168
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100521780
—
KY
Enumeration date
03/08/2021
Last updated
03/08/2021
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