Provider Demographics
NPI:1982607610
Name:CARRICO, JEFFREY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:CARRICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2337
Mailing Address - Country:US
Mailing Address - Phone:270-251-3223
Mailing Address - Fax:270-251-3220
Practice Address - Street 1:318 S 7TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2337
Practice Address - Country:US
Practice Address - Phone:270-251-3223
Practice Address - Fax:270-251-3220
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000612630OtherANTHEM
KY00975OtherMEDICARE GROUP
KY193400000XOtherGROUP TAXONOMY CODE
KY00587489OtherANTHEM MEDICAID GROUP
KY00589774OtherANTHEM MEDICAID
KY599186OtherWELLCARE
KY64281637Medicaid
KY7100083510OtherMEDICIAD PHY GRP
KY7100083510OtherMEDICIAD PHY GRP
KY599186OtherWELLCARE
KYF23745Medicare UPIN