Jaynie Stumbo Watts
Individual provider Active NPI Contractor · MC Dowell, KY
NPI 1164634762 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164634762
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 02024 (KY)
- Practice address
- 153 Johnson Rd.
MC Dowell, KY 41647 - Phone
- (606) 377-2379
- NPI assigned
- May 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02024 | KY | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 02024 | KY | Yes |
Addresses
Primary practice location
153 Johnson Rd.
MC Dowell, KY 41647
Mailing address
153 Johnson Rd.
MC Dowell, KY 41647
Phone (606) 377-2379
Other providers in MC Dowell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.