Provider Demographics
NPI:1629305263
Name:STORY, JENNIFER LYN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:STORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:PIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1011 PARIS RD
Mailing Address - Street 2:SUITE 341
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-3306
Mailing Address - Country:US
Mailing Address - Phone:270-251-0907
Mailing Address - Fax:270-251-0908
Practice Address - Street 1:1011 PARIS RD
Practice Address - Street 2:SUITE 341
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-3306
Practice Address - Country:US
Practice Address - Phone:270-251-0907
Practice Address - Fax:270-251-0908
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006000363LF0000X
KY1098654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100103020Medicaid
KY7100103020Medicaid