Provider Demographics
NPI:1851303960
Name:MYERS, JENNIFER (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD STE A300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3787
Mailing Address - Country:US
Mailing Address - Phone:859-276-4429
Mailing Address - Fax:859-276-5910
Practice Address - Street 1:24 CLINIC DR STE A
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2166
Practice Address - Country:US
Practice Address - Phone:859-276-4429
Practice Address - Fax:859-276-5910
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3317P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000355401OtherANTHEM
KY78014115Medicaid
KY0527627Medicare ID - Type Unspecified
KY0527427Medicare ID - Type Unspecified
KY0573727Medicare ID - Type Unspecified
KY0527727Medicare ID - Type Unspecified
KY78014115Medicaid
KY0682302Medicare ID - Type Unspecified
KY000000355401OtherANTHEM
KY0573127Medicare ID - Type Unspecified
KY0573227Medicare ID - Type Unspecified
KY0573917Medicare ID - Type Unspecified
KY0789623Medicare ID - Type Unspecified