Provider Demographics
NPI:1184228553
Name:JAYNES FAMILY PRACTICE
Entity Type:Organization
Organization Name:JAYNES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-280-4000
Mailing Address - Street 1:PO BOX 2634
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-2634
Mailing Address - Country:US
Mailing Address - Phone:606-280-4000
Mailing Address - Fax:606-280-4051
Practice Address - Street 1:1013 MASTER ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1065
Practice Address - Country:US
Practice Address - Phone:606-304-3794
Practice Address - Fax:606-280-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care