Provider Demographics
NPI:1821897695
Name:JEREMIA 17:14 FAMILY MEDICINE
Entity type:Organization
Organization Name:JEREMIA 17:14 FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-995-9624
Mailing Address - Street 1:293 SHAGBARK RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:KY
Mailing Address - Zip Code:40051-6134
Mailing Address - Country:US
Mailing Address - Phone:270-995-9624
Mailing Address - Fax:270-995-9624
Practice Address - Street 1:301 BURKESVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1921
Practice Address - Country:US
Practice Address - Phone:270-384-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health