Individual
JESSE JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4009 WHITEBLOSSOM ESTATES CT, LOUISVILLE, KY 40241-4182
(502) 482-8200
(320) 201-2991
Mailing address
4009 WHITEBLOSSOM ESTATES CT, LOUISVILLE, KY 40241-4182
(502) 482-8200
(320) 201-2991
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49235
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100308130
—
KY
01
—
K163031
MEDICARE PTAN
KY
Enumeration date
03/27/2013
Last updated
07/26/2025
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