Provider Demographics
NPI:1518134386
Name:EMERY, JENNIFER BENGE (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BENGE
Last Name:EMERY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:BENGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4612 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3971
Mailing Address - Country:US
Mailing Address - Phone:502-804-4811
Mailing Address - Fax:
Practice Address - Street 1:427 US 31W BYP STE 202
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1703
Practice Address - Country:US
Practice Address - Phone:270-796-6160
Practice Address - Fax:270-904-5774
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244139213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100053150Medicaid
KY000001030969OtherANTHEM
KYP01709763OtherRAILROAD MEDICARE
KYP01709763OtherRAILROAD MEDICARE
KYK018331Medicare PIN
KY000001030969OtherANTHEM
KY0713103Medicare PIN