Healthcare Provider Details

I. General information

NPI: 1770940736
Provider Name (Legal Business Name): JENNIFER NICOLE JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KY 225
BARBOURVILLE KY
40906
US

IV. Provider business mailing address

101 KETCHAM ST APT 4
BARBOURVILLE KY
40906-1849
US

V. Phone/Fax

Practice location:
  • Phone: 859-209-2340
  • Fax:
Mailing address:
  • Phone: 859-209-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number273404
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: