Miranda Jo Jewell, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

3011720 Issued in KY

Practice address

301 Professional Park Dr
Glasgow, KY 42141-3487

Phone

(270) 651-9696

Fax

(270) 651-0385

NPI assigned

Sep 17, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Miranda Jo Staples Former name

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cumberland Family Medical Center Inc

  dba Cumberland Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Burkesville, KY
  • NPI 1306873500
  Medicare reassignment NPD
• Cumberland Family Medical Center Inc

  dba Metcalfe County Middle Healthy Kids Clinic

  • Federally Qualified Health Center (FQHC)
  • Edmonton, KY
  • NPI 1548953672
  NPD
• Cumberland Family Medical Center Inc

  dba Women's Care for the Commonwealth

  • Federally Qualified Health Center (FQHC)
  • Danville, KY
  • NPI 1215918917
  NPD (past)
• Cumberland Family Medical Center Inc

  dba Greensburg Family Medical

  • Federally Qualified Health Center (FQHC)
  • Greensburg, KY
  • NPI 1518539444
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1437678810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-858-6644",
            "fax_number": "270-858-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PROFESSIONAL PARK DR",
            "city": "GLASGOW",
            "state": "KY",
            "postal_code": "421413487",
            "telephone_number": "270-651-9696",
            "fax_number": "270-651-0385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEWELL",
        "first_name": "MIRANDA",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "KY",
            "license": "3011720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY MEDICAL LICENSE",
            "identifier": "3011720",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "STAPLES",
            "middle_name": "JO",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James C Thurman DMD Inc
• James M Rynerson, MD, PSC
• Sarah Elizabeth Jennings
• Tammy Lynne Jennings, ARNP
• Julianne Jessie
• Ivan T Jines, LPCC
• John J Jones, D.C., P.S.C.
• Lauren Elizabeth Johnson, CSW
• Mania Johnson, CSW
• Victoria Johnson, MD

• Pediatric Nurse Practitioner in Glasgow, KY
• Providers in Glasgow, KY by specialty
• Pediatric Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.