Jessica N Anderson

Individual provider Active NPI Peer Specialist · Elizabethtown, KY

NPI 1760120133 · NPPES record last updated May 25, 2022

Key facts

NPI
1760120133
Entity type
Individual (NPI type 1)
Primary specialty
Peer Specialist 175T00000X
License
1204489 (KY)
Practice address
100 Diecks Dr
Elizabethtown, KY 42701-2443
Phone
(270) 319-6570
NPI assigned
May 25, 2022
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1204489KYMDPeer Specialist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X 1204489 KY Yes

Addresses

Primary practice location

100 Diecks Dr
Elizabethtown, KY 42701-2443

Mailing address

100 Diecks Dr
Elizabethtown, KY 42701-2443
Phone (270) 319-6570

Other providers in Elizabethtown, KY

All providers in Elizabethtown, KY · Peer Specialist in Kentucky

Sources for this page

Verify at the official NPI Registry.