Healthcare Provider Details

I. General information

NPI: 1467568741
Provider Name (Legal Business Name): STACEY ELIZABETH MERRITT-JENNEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 DUTCHMANS LN
LOUISVILLE KY
40205-3271
US

IV. Provider business mailing address

6200 DUTCHMANS LN
LOUISVILLE KY
40205-3269
US

V. Phone/Fax

Practice location:
  • Phone: 502-456-6200
  • Fax: 502-456-6655
Mailing address:
  • Phone: 502-456-6200
  • Fax: 502-456-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number28829
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number01041029A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28829
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01041029A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: