Individual
JORDAN BROOKE FENTRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
913 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2503
(270) 706-1212
Mailing address
605 FOXFIRE RD, ELIZABETHTOWN, KY 42701-9412
(270) 872-9485
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4026549
KY
Other
Enumeration date
07/15/2024
Last updated
08/21/2024
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