Provider Demographics
NPI:1295119915
Name:MOLINA, JERRI L (APRN)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:L
Last Name:MOLINA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JERRI
Other - Middle Name:L
Other - Last Name:HARLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W MUHAMMAD ALI BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1423
Mailing Address - Country:US
Mailing Address - Phone:502-589-8600
Mailing Address - Fax:502-287-0662
Practice Address - Street 1:130 S JOE B HALL AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6009
Practice Address - Country:US
Practice Address - Phone:502-589-8600
Practice Address - Fax:502-267-0662
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005617A363LP0808X
KY3009543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100353660Medicaid