Healthcare Provider Details

I. General information

NPI: 1730771700
Provider Name (Legal Business Name): JESSICA RIO-MARIE TRUMPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E CHESTNUT ST
LOUISVILLE KY
40202-1821
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6789
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-4750
  • Fax: 502-629-4617
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4047833
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: