Healthcare Provider Details

I. General information

NPI: 1295046688
Provider Name (Legal Business Name): JENNIFER J SKORUPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 SIR BARTON WAY STE 303
LEXINGTON KY
40509-2549
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 859-340-3233
  • Fax:
Mailing address:
  • Phone: 248-266-4200
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46234
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number46234
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: