| Jaynes Family Practice | |
|
1013 Master St Corbin KY 40701-1065 | |
| (606) 304-3794 | |
| (606) 280-4051 |
| Full Name | Jaynes Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1013 Master St, Corbin, Kentucky |
| Authorized Official Name and Position | Leslie Gayle Phelps (OWNER) |
| Authorized Official Contact | 6062804000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jaynes Family Practice Po Box 2634 Corbin KY 40702-2634 Ph: (606) 280-4000 | Jaynes Family Practice 1013 Master St Corbin KY 40701-1065 Ph: (606) 304-3794 |
| NPI Number | 1184228553 |
|---|---|
| Provider Enumeration Date | 11/25/2020 |
| Last Update Date | 06/24/2022 |
| Medicare PECOS PAC ID | 3779992573 |
|---|---|
| Medicare Enrollment ID | O20220916000145 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184228553 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | David Edward Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811251234 PECOS PAC ID: 5092968313 Enrollment ID: I20130116000346 |
| Provider Name | Leslie Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598005654 PECOS PAC ID: 0143466441 Enrollment ID: I20130410000638 |
| Provider Name | Cassaidy Hendrickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679962872 PECOS PAC ID: 8123343563 Enrollment ID: I20150206000776 |
| Provider Name | Deborah Ann Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962956268 PECOS PAC ID: 5294014528 Enrollment ID: I20161109001533 |
| Provider Name | Kellie Laymon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609587385 PECOS PAC ID: 7416306626 Enrollment ID: I20240115000093 |
| Provider Name | Pamela Macedonia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386417939 PECOS PAC ID: 5597106815 Enrollment ID: I20240516003087 |
| Provider Name | Kaylin Saylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205613098 PECOS PAC ID: 8628516721 Enrollment ID: I20240821000478 |
| Provider Name | Kayla Hendrickson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518785484 PECOS PAC ID: 1557897147 Enrollment ID: I20241205002955 |
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