Individual
JAMIE A. KALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
100 NORTH EAGLE CREEK DRIVE, LEXINGTON, KY 40509
(859) 258-5102
(859) 258-5177
Mailing address
350 ELAINE DR, SUITE 204, LEXINGTON, KY 40504-2754
(859) 258-4508
(859) 258-6122
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA506
KY
363AM0700X
Medical Physician Assistant
PA506
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0169
MEDICARE GROUP ID
KY
01
—
37903705
MEDICAID LAB GROUP#
KY
01
—
4000501
MEDICARE LAB GROUP#
KY
05
—
95000212
—
KY
01
—
970021224
RR MEDICARE PIN#
KY
01
—
CB 5773
RR MEDICARE GROUP#
KY
Enumeration date
10/03/2006
Last updated
07/18/2011
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