Provider Demographics
NPI:1629720180
Name:JESSICA ANGLIN NP PLLC
Entity Type:Organization
Organization Name:JESSICA ANGLIN NP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-635-6360
Mailing Address - Street 1:5137 STATE ROUTE 56 E
Mailing Address - Street 2:
Mailing Address - City:SEBREE
Mailing Address - State:KY
Mailing Address - Zip Code:42455-9144
Mailing Address - Country:US
Mailing Address - Phone:270-635-6360
Mailing Address - Fax:
Practice Address - Street 1:5137 STATE ROUTE 56 E
Practice Address - Street 2:
Practice Address - City:SEBREE
Practice Address - State:KY
Practice Address - Zip Code:42455-9144
Practice Address - Country:US
Practice Address - Phone:270-635-6360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service