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General NPI Number Information
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NPI Number | 1083872774
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Entity Type | Individual
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Provider Name | JESSICA L KAVANAUGH MD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2250 LEESTOWN RD
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City | LEXINGTON
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State | KY
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Zip | 40511-1052
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Country | US
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Telephone | 859-233-4511
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Fax | 859-281-3801
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Provider Business Mailing Address
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Address Line | 2250 LEESTOWN RD
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City | LEXINGTON
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State | KY
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Zip | 40511-1052
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Country | US
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Telephone | 859-233-4511
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Fax | 859-281-3801
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 35-094893
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 48980
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License Number State | KY
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