Provider Demographics
NPI:1255470597
Name:KIRTLEY, JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:KIRTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:PITTENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS 138 LEADER AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-9983
Mailing Address - Country:US
Mailing Address - Phone:859-323-5962
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:H404
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42381208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100077480Medicaid
KY7100077480Medicaid