Healthcare Provider Details

I. General information

NPI: 1942732912
Provider Name (Legal Business Name): MARY HELEN MANLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY HELEN JENNINGS MD

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 NEW MOODY LN STE 202A
LA GRANGE KY
40031-9177
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 502-225-5520
  • Fax: 502-225-5521
Mailing address:
  • Phone: 502-253-4924
  • Fax: 502-489-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55320
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55320
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4557
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTP156
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: