Healthcare Provider Details

I. General information

NPI: 1891012811
Provider Name (Legal Business Name): JEFFREY TUTTLE, M.D., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 E HIGH ST
LEXINGTON KY
40507-1409
US

IV. Provider business mailing address

219 E HIGH ST
LEXINGTON KY
40507-1409
US

V. Phone/Fax

Practice location:
  • Phone: 859-537-7332
  • Fax: 859-258-9209
Mailing address:
  • Phone: 859-537-7332
  • Fax: 859-258-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number40860
License Number StateKY

VIII. Authorized Official

Name: DR. JEFFREY TUTTLE
Title or Position: MEMBER
Credential: M.D.
Phone: 859-537-7332