Provider Demographics
NPI:1134762370
Name:DOWELL, JESSICA NICOLE (MED, LPA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:DOWELL
Suffix:
Gender:F
Credentials:MED, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11824 RANSUM DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2802
Mailing Address - Country:US
Mailing Address - Phone:502-338-0608
Mailing Address - Fax:502-245-1888
Practice Address - Street 1:11824 RANSUM DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2802
Practice Address - Country:US
Practice Address - Phone:502-338-0608
Practice Address - Fax:502-245-1888
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260060103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY260060OtherKENTUCKY