Provider Demographics
NPI:1023153152
Name:JASPER, KATHRYN SUSAN (APRN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:SUSAN
Last Name:JASPER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:STEARNS
Mailing Address - State:KY
Mailing Address - Zip Code:42647-0028
Mailing Address - Country:US
Mailing Address - Phone:606-376-9700
Mailing Address - Fax:606-376-9703
Practice Address - Street 1:2157 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STEARNS
Practice Address - State:KY
Practice Address - Zip Code:42647-6297
Practice Address - Country:US
Practice Address - Phone:606-376-9700
Practice Address - Fax:606-376-9703
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003050Medicaid
0248603Medicare ID - Type Unspecified
KY78003050Medicaid