Individual provider Active NPI

Jessika Young Purcell, DO

  • Pediatrics Physician
  • Leitchfield, KY
National Provider Identifier
1891372314
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
05821 Issued in KY
Practice address
901 Wallace Ave
Leitchfield, KY 42754-1417
Phone
(270) 259-5641
Fax
(270) 259-5309
NPI assigned
Mar 29, 2021
Last updated
Jun 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 05821 KY Primary

Addresses

Primary practice location

901 Wallace Ave
Leitchfield, KY 42754-1417

Mailing address

901 Wallace Ave
Leitchfield, KY 42754-1417
Phone (270) 259-5641

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240819003619 KY Practitioner - Pediatric Medicine 3476091646 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
05821KYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Leitchfield Pediatric Clinic P.S.C. Pediatrics CurrentSince Jun 25, 2024 Accepting new patients
Owensboro Health Twin Lakes Regional Medical Center, Inc Past Accepting new patients

Locations

901 Wallace Ave
Leitchfield, KY 42754
Phone (270) 259-5641

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61385

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1616976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1891372314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 WALLACE AVE",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427541417",
            "telephone_number": "270-259-5641",
            "fax_number": "270-259-5309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 WALLACE AVE",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427541417",
            "telephone_number": "270-259-5641",
            "fax_number": "270-259-5309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURCELL",
        "first_name": "JESSIKA",
        "middle_name": "YOUNG",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-29",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "05821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leitchfield, KY

Sources for this page

Verify at the official NPI Registry.