Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 12010855A | IN |
N | 213EG0000X | General Practice | 12010855A | IN |
Y | 1223G0001X | General Practice | 8399 | KY |
Y | 213EG0000X | General Practice | 8399 | KY |
N | 1223P0221X | Pediatric Dentist | 8399 | KY |
NPI | 1033270657 |
---|---|
Provider Name | Dr. Jennifer S. Board |
First Address | Lexington, KY 40505-4153 |
Second Address | Lexington, KY 40505-4153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 30/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200835020 | (05) | IN |