Provider Demographics
NPI:1881857886
Name:JACKSON, WENDY LEE (MD)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:CHANDLER MEDICAL CENTER-OB/GYN
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536
Mailing Address - Country:US
Mailing Address - Phone:859-257-2323
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:CHANDLER MEDICAL CENTER-OB/GYN
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-257-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41928207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41928OtherKENTUCKY BOARD OF MEDICAL LICENSURE
KYBN9517042OtherDEA