1609018423 NPI number — JANEL JENE WILLINGHAM ARNP

Table of content: JANEL JENE WILLINGHAM ARNP (NPI 1609018423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609018423 NPI number — JANEL JENE WILLINGHAM ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLINGHAM
Provider First Name:
JANEL
Provider Middle Name:
JENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1609018423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-272-5754
Provider Business Mailing Address Fax Number:
502-272-5339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 DUPONT RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-559-1855
Provider Business Practice Location Address Fax Number:
502-394-3658
Provider Enumeration Date:
03/25/2009

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: 363LF0000X , with the licence number:  5089P , 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)

  • Identifier: 108053 . This is a "SIHO NLPCC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3754966000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100097120 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50026910 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000627881 . This is a "ANTHEM NLPCC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 610978438T . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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