1285789701 NPI number — MS. JENNIFER KATHRYN SUTHERLAND MS EDS

Table of content: MS. JENNIFER KATHRYN SUTHERLAND MS EDS (NPI 1285789701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285789701 NPI number — MS. JENNIFER KATHRYN SUTHERLAND MS EDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTHERLAND
Provider First Name:
JENNIFER
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS EDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENSON
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
SUTHERLAND
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS EDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285789701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2315 BETHEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICHOLASVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-433-9526
Provider Business Mailing Address Fax Number:
866-266-0695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 WIND HAVEN DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
NICHOLASVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40356-8035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-0077
Provider Business Practice Location Address Fax Number:
866-266-0695
Provider Enumeration Date:
01/24/2007

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: 103T00000X , with the licence number:  0054 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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