Provider Demographics
NPI:1568457398
Name:BOURNE, JENNIE KAYE (MSN, RN, ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:KAYE
Last Name:BOURNE
Suffix:
Gender:F
Credentials:MSN, RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:300 S 8TH ST STE 401E
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2444
Mailing Address - Country:US
Mailing Address - Phone:270-753-2444
Mailing Address - Fax:270-767-3644
Practice Address - Street 1:300 S 8TH ST STE 401E
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-753-2444
Practice Address - Fax:270-752-2865
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3005174363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY363LA2200XOtherTAXONOMY
KY7100016740Medicaid
KY000000535238OtherBC/BS
KY7100016740Medicaid
KY7100016740Medicaid
KY363LA2200XOtherTAXONOMY