Provider Demographics
NPI:1255327805
Name:METTU, JYOTHI (MD)
Entity Type:Individual
Prefix:
First Name:JYOTHI
Middle Name:
Last Name:METTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 TOWN MOUNTAIN RD
Mailing Address - Street 2:STE 108
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1640
Mailing Address - Country:US
Mailing Address - Phone:606-437-4925
Mailing Address - Fax:606-437-4930
Practice Address - Street 1:387 TOWN MOUNTAIN RD
Practice Address - Street 2:STE 108
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1640
Practice Address - Country:US
Practice Address - Phone:606-437-4925
Practice Address - Fax:606-437-4930
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY219552080S0012X, 208000000X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64219553Medicaid
WV3003066000Medicaid
KY64219553Medicaid