Provider Demographics
NPI:1881674059
Name:LAY, JEWELL B (FNP)
Entity Type:Individual
Prefix:MS
First Name:JEWELL
Middle Name:B
Last Name:LAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JEWELL
Other - Middle Name:BURKHART
Other - Last Name:FLEETWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3587 NOBOB RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-8831
Mailing Address - Country:US
Mailing Address - Phone:270-428-4067
Mailing Address - Fax:
Practice Address - Street 1:299 GLASGOW RD
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-9696
Practice Address - Country:US
Practice Address - Phone:270-864-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3474P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P42196Medicare UPIN