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General NPI Number Information
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NPI Number | 1255865895
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Entity Type | Individual
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Provider Name | KELLY ANNE JENKINS MD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 2933 BRECKENRIDGE LN STE 103
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City | LOUISVILLE
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State | KY
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Zip | 40220-1494
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Country | US
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Telephone | 502-394-5678
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Fax | 502-394-5600
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-0001
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5339
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 35.145052
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4351029354
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | 58034
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License Number State | KY
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