Individual
MRS. CALLIE JO JERVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C/APRN
Contact information
Practice address
255 CHURCH ST STE 101, PIKEVILLE, KY 41501-3476
(606) 260-8613
(859) 977-2683
Mailing address
PO BOX 21890, BELFAST, ME 04915-4115
(502) 907-0356
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024174414
VA
363LF0000X
Family Nurse Practitioner
Primary
3010945
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001485530
ANTHEM
—
01
—
297980
SIHO
—
05
—
7100478510
—
KY
01
—
CS2115300253
CARESOURCE
—
01
—
PDZ000000028490
AETNA BETTER HEALTH
KY
Enumeration date
02/19/2017
Last updated
06/09/2022
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