Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 1110443 | KY |
NPI | 1013318088 |
---|---|
Provider Name | Jessie Meiser |
First Address | Paducah, KY 42001-4056 |
Second Address | Paducah, KY 42001-4056 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 10/09/2014 |