MEDICARE: JESSICA DOTY KLAUSING RN, BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SL0600X	Long-Term Care Clinical Nurse Specialist	1097974	KY

General Provider Information

NPI Number	:	1487221297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DOTY KLAUSING RN, BSN

Provider Business Mailing Address
First Line	:	1616 FOREST HILL DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2454
Country	:	US
Telephone Number	:	502-417-2115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 FOREST HILL DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-2454
Country	:	US
Telephone Number	:	502-417-2115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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