Provider Demographics
NPI:1801917570
Name:JETT, KATHERINE HARTIGAN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:HARTIGAN
Last Name:JETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:HARTIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:1031 NEW MOODY LN
Practice Address - Street 2:SUITE 301
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9189
Practice Address - Country:US
Practice Address - Phone:502-225-5520
Practice Address - Fax:502-225-5522
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43574208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100124040Medicaid
KY50029750OtherPASSPORT