Organization
BLUEGRASS INTERNAL MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA LOUISE JARVIS M.D. (PRESIDENT)
(270) 685-1066
Entity
Organization
Contact information
Practice address
3346 PROFESSIONAL PARK DR, OWENSBORO, KY 42303-4551
(270) 685-1066
(270) 685-0881
Mailing address
3346 PROFESSIONAL PARK, OWENSBORO, KY 42303-4551
(270) 685-1066
(270) 685-0881
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65935470
—
KY
05
—
78902251
—
KY
Enumeration date
06/24/2005
Last updated
03/24/2021
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