Provider Demographics
NPI:1902828114
Name:CAMAS, JENNIFER A (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:CAMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6801 OWENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-7752
Mailing Address - Country:US
Mailing Address - Phone:270-230-3411
Mailing Address - Fax:
Practice Address - Street 1:210 S MAIN ST # 101
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9001
Practice Address - Country:US
Practice Address - Phone:270-975-4050
Practice Address - Fax:866-809-8145
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40180207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000502401OtherANTHEM
KY64125511Medicaid
KY0667405Medicare PIN
KY000000502401OtherANTHEM