Healthcare Provider Details

I. General information

NPI: 1295133635
Provider Name (Legal Business Name): DR. JODY HOWLAND PIMENTEL-EYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W HIGHWAY 146
LA GRANGE KY
40032-0001
US

IV. Provider business mailing address

3001 W HIGHWAY 146
LA GRANGE KY
40032-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-9441
  • Fax:
Mailing address:
  • Phone: 502-222-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1754
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: