Healthcare Provider Details

I. General information

NPI: 1104145101
Provider Name (Legal Business Name): JENNIFER MARIE WHITTINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE WHITTINGTON MD

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET GENERAL SURGERY
LEXINGTON KY
40536
US

IV. Provider business mailing address

888 MAIN ST APT 138
NEW YORK NY
10044-0214
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6162
  • Fax: 859-257-8934
Mailing address:
  • Phone: 423-483-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR2402
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46460
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number286633
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: