Provider Demographics
NPI:1396357729
Name:STILLWELL, JENNIFER GAYLE (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GAYLE
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OVERLOOK ESTATES DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165
Mailing Address - Country:US
Mailing Address - Phone:502-264-1403
Mailing Address - Fax:
Practice Address - Street 1:202 OVERLOOK ESTATES DRIVE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165
Practice Address - Country:US
Practice Address - Phone:502-264-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2035227164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse