Healthcare Provider Details

I. General information

NPI: 1760119721
Provider Name (Legal Business Name): JESSICA DOWNING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESI DOWNING

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEXINGTON RD STE A&B
RICHMOND KY
40475-7924
US

IV. Provider business mailing address

2150 LEXINGTON RD STE A&B
RICHMOND KY
40475-7924
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-5445
  • Fax:
Mailing address:
  • Phone: 859-353-5445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number278950
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number280444
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: