1235148750 NPI number — JENNIFER B CATLETT M.D.

Table of content: JENNIFER B CATLETT M.D. (NPI 1235148750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235148750 NPI number — JENNIFER B CATLETT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATLETT
Provider First Name:
JENNIFER
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235148750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 LONGEST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40204-2127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-216-4677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 N EAGLE CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-1889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-523-2526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  35800 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 01060265A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50021288 . This is a "PASSPORT - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533079 . This is a "MEDICARE - WSPEC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100073860 . This is a "MEDICAID - KY - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100007 . This is a "SIHO - NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3691798000 . This is a "PASSPORT ADVTG - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000596335 . This is a "ANTHEM - WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023034W . This is a "HUMANA -WS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200526190 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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