Healthcare Provider Details

I. General information

NPI: 1578701223
Provider Name (Legal Business Name): JESSICA LYNN SCHUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11213 BEARCAMP RD
LOUISVILLE KY
40272-1913
US

IV. Provider business mailing address

11213 BEARCAMP RD
LOUISVILLE KY
40272-1913
US

V. Phone/Fax

Practice location:
  • Phone: 502-338-1370
  • Fax: 502-337-3149
Mailing address:
  • Phone: 502-338-1370
  • Fax: 502-337-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47960
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: