Healthcare Provider Details

I. General information

NPI: 1831200336
Provider Name (Legal Business Name): JENNIFER S. RIEBEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

2913 FRANKFORT RD
GEORGETOWN KY
40324-9146
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-6426
  • Fax:
Mailing address:
  • Phone: 502-867-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29729
License Number StateKY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1200220
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerUNITED HEALTH CARE
# 2
Identifier4649312
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerAETNA
# 3
Identifier64297294
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer
# 4
Identifier000000049849
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerANTHEM
# 5
Identifier611215814
Identifier TypeOTHER
Identifier StateKY
Identifier IssuerBLUEGRASS FAMILY HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: