Provider Demographics
NPI:1437202918
Name:WOOLDRIDGE, JONI LEA (MD)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:LEA
Last Name:WOOLDRIDGE
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:PO BOX 950293
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0293
Mailing Address - Country:US
Mailing Address - Phone:502-895-0524
Mailing Address - Fax:502-897-5798
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 15
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-895-0524
Practice Address - Fax:502-897-5798
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24721208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051847OtherANTHEM
KY64247216Medicaid
KY1049499OtherPASSPORT