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304 E Main St Wilmore KY 40390-1374 | |
| (859) 320-1170 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 304 E Main St, Wilmore, Kentucky |
| Authorized Official Name and Position | Blake Jones (OWNER) |
| Authorized Official Contact | 8598062161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1396 Hall Rd Nicholasville KY 40356-9540 Ph: (859) 320-1170 | 304 E Main St Wilmore KY 40390-1374 Ph: (859) 320-1170 |
| NPI Number | 1265180574 |
|---|---|
| Provider Enumeration Date | 03/15/2022 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Medicare PECOS PAC ID | 3779015219 |
|---|---|
| Medicare Enrollment ID | O20241022002337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265180574 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Blake Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710194386 PECOS PAC ID: 5799946893 Enrollment ID: I20120417000759 |
| Provider Name | Cassandra Dawn Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619719838 PECOS PAC ID: 0244765006 Enrollment ID: I20241203002038 |
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