Healthcare Provider Details

I. General information

NPI: 1407674666
Provider Name (Legal Business Name): JAMIE ROIG DR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3499 BLAZER PKWY STE 170
LEXINGTON KY
40509-2823
US

IV. Provider business mailing address

109 WIND HAVEN DR STE 100
NICHOLASVILLE KY
40356-8010
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-2273
  • Fax: 859-224-4675
Mailing address:
  • Phone: 859-224-2273
  • Fax: 859-224-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number290834
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: