Provider Demographics
NPI:1629540711
Name:GONDOLY, JENNIFER L (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GONDOLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17108 HILLROCK PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7560
Mailing Address - Country:US
Mailing Address - Phone:517-449-1677
Mailing Address - Fax:
Practice Address - Street 1:2301 TERRA CROSSING BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-3909
Practice Address - Country:US
Practice Address - Phone:502-410-0191
Practice Address - Fax:502-890-5177
Is Sole Proprietor?:No
Enumeration Date:2018-12-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily