Provider Demographics
NPI:1447271135
Name:PATTERSON, JENIFER J (APRN)
Entity type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3991 DUTCHMANS LN STE 310
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4716
Practice Address - Country:US
Practice Address - Phone:502-899-6411
Practice Address - Fax:502-899-6413
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4887P363L00000X
KY3004887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200877190Medicaid
KY78017365Medicaid
KY7058103OtherCIGNA - NNS
KY000000679321OtherANTHEM - NNS
KY066174OtherSIHO - NNS
KY50030469OtherPASSPORT & PASSPORT ADVTG - NNS
KYP01148978OtherRAILROAD MEDICARE
KYP400028567OtherMEDICARE PTAN - NNS
KY000057058QOtherHUMANA - NNS
KY50030469OtherPASSPORT & PASSPORT ADVTG - NNS