Healthcare Provider Details

I. General information

NPI: 1902828114
Provider Name (Legal Business Name): JENNIFER A CAMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER WADE

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST # 101
BROWNSVILLE KY
42210-9001
US

IV. Provider business mailing address

6801 OWENSBORO RD
LEITCHFIELD KY
42754-7752
US

V. Phone/Fax

Practice location:
  • Phone: 270-975-4050
  • Fax: 866-809-8145
Mailing address:
  • Phone: 270-230-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40180
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40180
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: