Individual
MRS. ANGELA M JESSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
109 SARTIN DR, EDMONTON, KY 42129-8170
(270) 432-2444
(270) 432-2445
Mailing address
PO BOX 1080, BURKESVILLE, KY 42717-1080
(270) 858-6655
(270) 858-4027
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3003026
KY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
3003026
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11386204
CAQH
KY
05
—
78003944
—
KY
Enumeration date
02/03/2006
Last updated
06/20/2024
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