Individual
DR. JERSEY RAE METTILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5851
(502) 852-3762
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
05256
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300064094
—
IN
05
—
7100821040
—
KY
Enumeration date
03/26/2018
Last updated
07/18/2022
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