Individual
KURT JAENICKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
412 N LOCK AVE, LOUISA, KY 41230-1115
(606) 638-4595
Mailing address
PO BOX 5009, BRENTWOOD, TN 37024-5009
(615) 221-1400
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
16950
WV
207V00000X
Obstetrics & Gynecology Physician
31309
KY
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
16950
WV
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
31309
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000510048
ANTHEM BCBS
KY
01
—
000000583794
ANTHEM BCBS
KY
05
—
0163719
—
OH
05
—
64313091
—
KY
Enumeration date
12/05/2006
Last updated
04/26/2022
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