Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3006597 | KY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 6597 | KY |
NPI | 1003122201 |
---|---|
Provider Name | Jacob William Harvey JR. |
First Address | Louisville, KY 40216-4163 |
Second Address | Louisville, KY 40216-4163 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100136720 | (05) | KY |
K027710 | MEDICARE- NICC (01) | KY |