Healthcare Provider Details

I. General information

NPI: 1114842549
Provider Name (Legal Business Name): JO BABB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SAINT ANDREWS RD
BRANDENBURG KY
40108-7163
US

IV. Provider business mailing address

777 SAINT ANDREWS RD
BRANDENBURG KY
40108-7163
US

V. Phone/Fax

Practice location:
  • Phone: 270-668-2694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number9371258769
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: