Provider Demographics
NPI:1578071874
Name:MILLARD, JENNIFER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ENGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4019 BALLARD WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40068-9324
Mailing Address - Country:US
Mailing Address - Phone:720-346-3070
Mailing Address - Fax:
Practice Address - Street 1:1000 LIMESTONE WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-5513
Practice Address - Country:US
Practice Address - Phone:720-346-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-21
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86044806133V00000X
KYTC073363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered