Provider Demographics
NPI:1013548916
Name:RINEY, JENNIFER W
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:RINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ANDERSON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-8022
Mailing Address - Country:US
Mailing Address - Phone:502-859-1772
Mailing Address - Fax:
Practice Address - Street 1:1300 ANDERSON CROSSING DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-8022
Practice Address - Country:US
Practice Address - Phone:502-859-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10224102L00000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst