| Jaynes Family Practice South Llc | |
|
1507 S Main St Corbin KY 40701-1932 | |
| (606) 280-4044 | |
| (833) 222-3797 |
| Full Name | Jaynes Family Practice South Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1507 S Main St, Corbin, Kentucky |
| Authorized Official Name and Position | Leslie Jaynes (OWNER) |
| Authorized Official Contact | 6063043794 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jaynes Family Practice South Llc 1507 S Main St Corbin KY 40701-1932 Ph: (606) 280-4044 | Jaynes Family Practice South Llc 1507 S Main St Corbin KY 40701-1932 Ph: (606) 280-4044 |
| NPI Number | 1245943356 |
|---|---|
| Provider Enumeration Date | 01/04/2023 |
| Last Update Date | 01/08/2023 |
| Certification Date | 01/08/2023 |
| Medicare PECOS PAC ID | 1052776523 |
|---|---|
| Medicare Enrollment ID | O20230505001607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245943356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Leslie Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598005654 PECOS PAC ID: 0143466441 Enrollment ID: I20130410000638 |
| Provider Name | Cassaidy Hendrickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679962872 PECOS PAC ID: 8123343563 Enrollment ID: I20150206000776 |
| Provider Name | Deborah Ann Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962956268 PECOS PAC ID: 5294014528 Enrollment ID: I20161109001533 |
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