Individual
JENNIFER L SUDDUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1401 HARRODSBURG RD, SUITE B-160, LEXINGTON, KY 40504-3751
(859) 276-4486
(859) 277-9164
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA687
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000271731
BLUE CROSS & BLUE SHIELD
KY
01
—
P00004815
RAILROAD MEDICARE
KY
Enumeration date
07/27/2006
Last updated
07/10/2019
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