Individual
JAMIE L CANNADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 MALLARD CREEK RD STE 320, LOUISVILLE, KY 40207-5136
(502) 855-6125
(502) 394-1972
Mailing address
100 MALLARD CREEK RD STE 320, LOUISVILLE, KY 40207-5136
(502) 855-6125
(502) 394-1972
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024172927
VA
363LF0000X
Family Nurse Practitioner
Primary
3016421
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
10/19/2015
Last updated
12/13/2021
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