Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3009990 | KY |
NPI | 1003272261 |
---|---|
Provider Name | Kaelin Jansen |
First Address | Louisville, KY 40295-0151 |
Second Address | Shepherdsville, KY 40165-7252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2016 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100408550 | (05) | KY |