Provider Demographics
NPI:1275132433
Name:SCHMUCKER, JOLENE CAROL
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:CAROL
Last Name:SCHMUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-1929
Mailing Address - Country:US
Mailing Address - Phone:270-776-7992
Mailing Address - Fax:
Practice Address - Street 1:775 PEMBROKE FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:KY
Practice Address - Zip Code:42266-9413
Practice Address - Country:US
Practice Address - Phone:270-962-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily