Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 9926 | KY |
Y | 1223P0221X | Pediatric Dentist | 9926 | KY |
NPI | 1063941961 |
---|---|
Provider Name | Dr. Jane Katherine Jones |
First Address | Lexington, KY 40502-9002 |
Second Address | Lexington, KY 40507-2109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 17/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100467830 | (05) | KY |