Individual
JEANIE L MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1301 PLEASANT VALLEY RD STE 300, OWENSBORO, KY 42303-9774
(270) 417-7830
(270) 417-7839
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 688-1330
(270) 688-1338
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
03682
KY
2084N0400X
Neurology Physician
34010264
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201259240
—
IN
05
—
7100309370
—
KY
Enumeration date
01/24/2008
Last updated
09/21/2023
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