Provider Demographics
NPI:1659766491
Name:THURMAN, JENNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:THURMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:327 EASTBROOKE POINTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-5561
Mailing Address - Country:US
Mailing Address - Phone:502-523-5090
Mailing Address - Fax:
Practice Address - Street 1:327 EASTBROOKE POINTE DR STE 200
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047
Practice Address - Country:US
Practice Address - Phone:502-523-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100430460Medicaid