Healthcare Provider Details

I. General information

NPI: 1073756284
Provider Name (Legal Business Name): JENNIFER ANN COLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARWILL DR STE 1
CARROLLTON KY
41008-1471
US

IV. Provider business mailing address

1951 BISHOP LN FL 4
LOUISVILLE KY
40218-1923
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-6956
  • Fax: 502-732-8209
Mailing address:
  • Phone: 502-732-6956
  • Fax: 502-732-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006002
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: