Angela M Jessie, APRN
Individual provider Active NPI Family Nurse Practitioner · Edmonton, KY
NPI 1720050818 · NPPES record last updated Jun 20, 2024
Key facts
- NPI
- 1720050818
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 3003026 (KY)
- Practice address
- 109 Sartin Dr
Edmonton, KY 42129-8170 - Phone
- (270) 432-2444
- Fax
- (270) 432-2445
- NPI assigned
- Feb 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cumberland Family Medical Center Inc
Practice addresses (Care Compare)
197 Will Walker Rd
Columbia, KY 42728-7436
Phone (270) 384-9981
360 Keen St
Burkesville, KY 42717-7915
Phone (270) 864-2889
600 Main St
Munfordville, KY 42765-9426
Phone (270) 524-2889
PO Box
Suite 1080
Burkesville, KY 42717
Hospital & facility affiliations
- T J Samson Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050921000559 | KY | Practitioner - Nurse Practitioner | 0547294332 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3003026 | KY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cumberland Family Medical Center Inc | Current |
Accepting new patients | |
| Cumberland Family Medical Center Inc | Current | Accepting new patients | |
| Cumberland Family Medical Center Inc | Current |
Accepting new patients | |
| Elderserve, Inc. | Past | Accepting new patients | |
| All About You Urgent Care | Past | Accepting new patients | |
| Cumberland Family Medical Center Inc | Past | Accepting new patients |
Locations
360 Keen St
Burkesville, KY 42717
Phone (270) 864-1472
197 Will Walker Rd
Columbia, KY 42728
Phone (270) 384-9981
612 W Stockton St
Edmonton, KY 42129
Phone (270) 432-2725
109 Sartin Dr
Edmonton, KY 42129
Phone (270) 432-2444
1150 Bypass N
Lawrenceburg, KY 40342
Phone (502) 839-4236
Interoperability endpoints
- lhaskinsfhl@direct.meditouchehr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 3003026 | KY | |
| Family Nurse Practitioner | 363LF0000X | 3003026 | KY | Yes |
Addresses
Primary practice location
109 Sartin Dr
Edmonton, KY 42129-8170
Mailing address
PO Box 1080
Burkesville, KY 42717-1080
Phone (270) 858-6655
Other practice location 1
903 W Stockton St
Building 1A
Edmonton, KY 42129-8120
Phone (270) 670-5960
Other practice location 2
903 W Stockton St
Building 1A
Edmonton, KY 42129-8120
Phone (270) 670-5960
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11386204 | Other | KY | CAQH |
| 78003944 | Medicaid | KY |
Other providers in Edmonton, KY
- H2 Rehabilitation Services of Kentucky, LLC
- Hadley Home Care LLC
- Ambria Winters White Hardison
- Krista Ennis Harlan
- Erik Hunley
- Brittney Jessie
- Kentucky Medical Supply, Inc.
- Georgetta Kingrey
- KSL Events LLC
- David Wayne Lassiter
All providers in Edmonton, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.