| Doctor Name: | MRS. JACKIE A. PANDEYA |
| NPI Number: | 1447588488 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | NP-13005 |
| Business Practice Address: | 950 Main St. Munfordville, KY - 42765 |
| Business Phone Number: | 2705241201 |
| Business Fax Number: | 2705241202 |
| Mailing Address: | 201 Park St, BOWLING GREEN |
| State: | KY |
| Postal Code: | 421011759 |
| Phone Number: | 2707802497 |
| Fax Number: | 2707830454 |
| NPI Enumeration Date: | 12/03/2009 |
| NPI Last Update Date: | 01/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP-13005 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |