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1467568741

NPI Code Detail

MEDICARE: STACEY ELIZABETH MERRITT-JENNEY MD

MEDICARE: STACEY ELIZABETH MERRITT-JENNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	28829	KY
2	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	01041029A	IN
3	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	28829	KY
4	207P00000X	Emergency Medicine Physician	01041029A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000185657	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1124516	OTHER	KY	PASSPORT
5	2437324000	OTHER	KY	PASSPORT ADVANTAGE

General Provider Information

NPI Number	:	1467568741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY ELIZABETH MERRITT-JENNEY MD

Provider Business Mailing Address
First Line	:	6200 DUTCHMANS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3271
Country	:	US
Telephone Number	:	502-456-6200
Fax Number	:	502-456-6655

Provider Business Practice Location Address
First Line	:	6200 DUTCHMANS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-3271
Country	:	US
Telephone Number	:	502-456-6200
Fax Number	:	502-456-6655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/27/2024

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Directions to “ STACEY ELIZABETH MERRITT-JENNEY MD” Practice Location

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