Provider Demographics
NPI:1912025743
Name:CHRISTIAN, JESSE (KCSA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N KEENELAND DR
Mailing Address - Street 2:STE. 4
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8597
Mailing Address - Country:US
Mailing Address - Phone:502-454-7788
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:425 N KEENELAND DR
Practice Address - Street 2:STE. 4
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8597
Practice Address - Country:US
Practice Address - Phone:502-454-7788
Practice Address - Fax:502-451-9291
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA130246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist