Provider Demographics
NPI:1457846230
Name:FICK, JENNIFER TILLEY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TILLEY
Last Name:FICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3106 DANBURY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-2909
Mailing Address - Country:US
Mailing Address - Phone:270-519-0847
Mailing Address - Fax:
Practice Address - Street 1:4600 SHELBYVILLE RD STE 220
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3398
Practice Address - Country:US
Practice Address - Phone:502-897-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011510363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3011510OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD