Individual
JESSICA THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 ABRAHAM FLEXNER WAY STE 100, LOUISVILLE, KY 40202-3841
(502) 587-8222
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-09012
NC
363A00000X
Physician Assistant
Primary
TC094
KY
Other
Enumeration date
06/03/2019
Last updated
11/20/2024
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