Provider Demographics
NPI:1619099744
Name:KIMES, JENNIFER LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOUISE
Last Name:KIMES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5001 S HURSTBOURNE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-2893
Mailing Address - Country:US
Mailing Address - Phone:502-495-5088
Mailing Address - Fax:502-495-5038
Practice Address - Street 1:5001 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-2893
Practice Address - Country:US
Practice Address - Phone:502-495-5088
Practice Address - Fax:502-495-5038
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1424103TC0700X
KY000066493222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist