Provider Demographics
NPI:1700213105
Name:JAGGERS, JUDITH JILL BOWLING (APRN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:JILL BOWLING
Last Name:JAGGERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:JILL
Other - Last Name:BOWLING JAGGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2425
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:496 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1827
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-288-7510
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012391363LF0000X
KY3008290363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3008290OtherAPRN LICENSE
FLAPRN11012391OtherSTATE LICENSE
KYK097974Medicare PIN