Healthcare Provider Details

I. General information

NPI: 1275388696
Provider Name (Legal Business Name): JANESSA MARIE JAMES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S ROY WILKINS AVE STE 100
LOUISVILLE KY
40203-2072
US

IV. Provider business mailing address

1016 SENATE AVE
JEFFERSONVILLE IN
47130-5760
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-4092
  • Fax: 502-371-6110
Mailing address:
  • Phone: 502-323-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4018760
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: