Provider Demographics
NPI:1548803273
Name:WITHROW, JESSICA L (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:WITHROW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-367-4500
Mailing Address - Fax:502-368-8139
Practice Address - Street 1:1900 BLUEGRASS AVE STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1144
Practice Address - Country:US
Practice Address - Phone:502-367-4500
Practice Address - Fax:502-368-8139
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3013205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner