Provider Demographics
NPI:1609018423
Name:WILLINGHAM, JANEL JENE (ARNP)
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:JENE
Last Name:WILLINGHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5754
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:901 DUPONT RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4644
Practice Address - Country:US
Practice Address - Phone:502-559-1855
Practice Address - Fax:502-394-3658
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5089P363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY108053OtherSIHO NLPCC
KY3754966000OtherPASSPORT ADVANTAGE
KY7100097120Medicaid
KY50026910OtherPASSPORT
KY000000627881OtherANTHEM NLPCC
KY610978438TOtherHUMANA
KY042312Medicare PIN