Organization
PARKWAY MED ASSOC PSC NURSE PRACT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKIE D MAXEY M.D. (OWNER)
(606) 878-9611
Entity
Organization
Contact information
Practice address
102 PROFESSIONAL DR, SUITE 2, LONDON, KY 40741-8857
(606) 878-9611
Mailing address
PO BOX 1676, LONDON, KY 40743-1676
(606) 878-9611
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
35548
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7890323400
—
KY
Enumeration date
01/29/2007
Last updated
03/16/2010
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