Provider Demographics
NPI:1811181175
Name:CARDEN, JILLIAN (PSYD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:CARDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 CRANES ROOST CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-3650
Mailing Address - Country:US
Mailing Address - Phone:270-765-2605
Mailing Address - Fax:270-234-8572
Practice Address - Street 1:1311 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2621
Practice Address - Country:US
Practice Address - Phone:270-765-2605
Practice Address - Fax:270-234-8572
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2008-106103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0690965Medicare PIN