Healthcare Provider Details

I. General information

NPI: 1841909272
Provider Name (Legal Business Name): JENNIFER ESTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 WILSON AVE
LOUISVILLE KY
40211-1969
US

IV. Provider business mailing address

3015 WILSON AVE
LOUISVILLE KY
40211-1969
US

V. Phone/Fax

Practice location:
  • Phone: 502-774-4401
  • Fax:
Mailing address:
  • Phone: 502-774-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3018067
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: