Provider Demographics
NPI:1770763054
Name:WOJCIK, JODI (ARNP)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:
Last Name:WOJCIK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 NEW CUT RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4271
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-955-3383
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-587-4840
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5395P363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100170060Medicaid
KYK079980Medicare PIN