Healthcare Provider Details

I. General information

NPI: 1699881730
Provider Name (Legal Business Name): KATHERINE LEEANN JAMISON ARNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 DECLARATION DR
INDEPENDENCE KY
41051-8441
US

IV. Provider business mailing address

66 DUDLEY PIKE
CRESTVIEW HILLS KY
41017-2372
US

V. Phone/Fax

Practice location:
  • Phone: 859-898-1608
  • Fax:
Mailing address:
  • Phone: 859-630-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3174P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003174
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: