1679501308 NPI number — MRS. JENNA LYNN BUCHANAN APRN

Table of content: MRS. JENNA LYNN BUCHANAN APRN (NPI 1679501308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679501308 NPI number — MRS. JENNA LYNN BUCHANAN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCHANAN
Provider First Name:
JENNA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURRAY
Provider Other First Name:
JENNA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679501308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JEFFERSONVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47130-3554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-282-1888
Provider Business Mailing Address Fax Number:
812-218-9318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 REGENCY RD. STE. 101
Provider Second Line Business Practice Location Address:
ACCESS WELLNESS GROUP
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-309-0309
Provider Business Practice Location Address Fax Number:
859-309-0914
Provider Enumeration Date:
06/29/2006

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: 363L00000X , with the licence number:  3007808 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 3007808 , 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: 000000056294 . This is a "ANTHEM GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000806055 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1487872636 . This is a "NPI GROUP NUMBER (ARNP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 184607 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100238160 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK2274 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 78903689 . This is a "KY MEDICAID ARNP GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01161549 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 6764 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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