Healthcare Provider Details

I. General information

NPI: 1609870427
Provider Name (Legal Business Name): JENNIFER ABBOTT HOLLON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 DUTCHMANS PKWY STE 250
LOUISVILLE KY
40205-3340
US

IV. Provider business mailing address

6400 DUTCHMANS PKWY STE 250
LOUISVILLE KY
40205-3340
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-9660
  • Fax: 502-540-5615
Mailing address:
  • Phone: 502-587-9660
  • Fax: 502-540-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35773
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: