Provider Demographics
NPI:1093339772
Name:JAGGERS, MELONY JILL (APRN)
Entity Type:Individual
Prefix:
First Name:MELONY
Middle Name:JILL
Last Name:JAGGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 OLD HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2519
Mailing Address - Country:US
Mailing Address - Phone:270-580-2250
Mailing Address - Fax:
Practice Address - Street 1:9798 KY-259
Practice Address - Street 2:
Practice Address - City:MCDANIELS
Practice Address - State:KY
Practice Address - Zip Code:40152-7127
Practice Address - Country:US
Practice Address - Phone:270-902-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57168363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care