Healthcare Provider Details

I. General information

NPI: 1104569565
Provider Name (Legal Business Name): JENNIFFER MARIE SOLIVAN ALBINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 MEDICAL CENTER CIR
MAYFIELD KY
42066-1179
US

IV. Provider business mailing address

1099 MEDICAL CENTER CIR
MAYFIELD KY
42066-1143
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD225644
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC5258
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: