Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 07001253A | IN |
Y | 213ES0103X | Foot & Ankle Surgery | 244078 | KY |
N | 213ES0103X | Foot & Ankle Surgery | POD001282 | GA |
NPI | 1023491073 |
---|---|
Provider Name | Jasmine Neal |
First Address | Louisville, KY 40219-3971 |
Second Address | Elizabethtown, KY 42701-7933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000001092707 | ANTHEM (01) | |
300004425 | (05) | IN |