Provider Demographics
NPI:1396922118
Name:JESSEE, ALI JANELL (DO)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:JANELL
Last Name:JESSEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3813
Mailing Address - Country:US
Mailing Address - Phone:270-575-8472
Mailing Address - Fax:270-415-4702
Practice Address - Street 1:543 POWELL LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5366
Practice Address - Country:US
Practice Address - Phone:270-415-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03422207P00000X, 207R00000X
OK8776207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396922118Medicaid
KY7100177730Medicaid