Individual
MR. JONATHON LEE ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
805 BARDSTOWN RD, SPRINGFIELD, KY 40069
(859) 481-7113
(859) 481-7114
Mailing address
805 BARDSTOWN RD, SPRINGFIELD, KY 40069-1513
(859) 481-7113
(859) 481-7114
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100515140
—
KY
Enumeration date
10/27/2017
Last updated
03/28/2019
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