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General NPI Number Information
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NPI Number | 1073671673
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Entity Type | Individual
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Provider Name | KURT JAENICKE MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 412 N LOCK AVE
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City | LOUISA
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State | KY
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Zip | 41230-1115
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Country | US
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Telephone | 606-638-4595
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5009
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City | BRENTWOOD
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State | TN
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Zip | 37024-5009
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Country | US
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Telephone | 615-221-1400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 31309
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 31309
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 16950
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License Number State | WV
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Taxonomy #4
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 16950
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License Number State | WV
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