Healthcare Provider Details

I. General information

NPI: 1619099744
Provider Name (Legal Business Name): JENNIFER LOUISE KIMES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 S HURSTBOURNE PKWY
LOUISVILLE KY
40291-2893
US

IV. Provider business mailing address

5001 S HURSTBOURNE PKWY
LOUISVILLE KY
40291-2893
US

V. Phone/Fax

Practice location:
  • Phone: 502-495-5088
  • Fax: 502-495-5038
Mailing address:
  • Phone: 502-495-5088
  • Fax: 502-495-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberKY-1424
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number000066493
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: