Organization
DAYSPRING HEALTH INC
Active
Other names
Dayspring Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN D HARRIS (CREDENTIALING)
(423) 784-8492
Entity
Organization
Contact information
Practice address
402 CUMBERLAND AVE, WILLIAMSBURG, KY 40769
(606) 549-2656
(606) 549-2855
Mailing address
107 S MAIN ST, P.O. BOX 540, JELLICO, TN 37762-2154
(423) 784-8492
(423) 784-8358
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
KY
207V00000X
Obstetrics & Gynecology Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
181827
KY
363A00000X
Physician Assistant
—
KY
363L00000X
Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18C7
ANTHEM BCBS
KY
01
—
206742
BLACK LUNG
KY
05
—
31000946
—
KY
01
—
7890332500
NP GROUP FOR KY MEDICAID
KY
Enumeration date
02/02/2007
Last updated
12/17/2021
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