MEDICARE: DR. MAKAYLA JENNINGS DO

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	390200000X	Student in an Organized Health Care Education/Training Program		IN

General Provider Information

NPI Number	:	1619819133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAKAYLA JENNINGS DO

Provider Business Mailing Address
First Line	:	800 ROSE ST RM M5
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0293
Country	:	US
Telephone Number	:	859-323-5083
Fax Number	:	859-323-8056

Provider Business Practice Location Address
First Line	:	800 ROSE ST RM M5
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0293
Country	:	US
Telephone Number	:	859-323-5083
Fax Number	:	859-323-8056

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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