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Individual

JENNIFER LEE FREDERICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
320 WHITTINGTON PKWY, SUITE 301, LOUISVILLE, KY 40222-4928
(502) 625-5584
(502) 426-2264
Mailing address
320 WHITTINGTON PKWY, SUITE 301, LOUISVILLE, KY 40222-4928
(502) 625-5584
(502) 426-2264

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5096A
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200873920
IN
01
2867285000
PASSPORT ADVANTAGE
KY
01
50016501
PASSPORT
KY
05
7100025040
KY
Enumeration date
10/17/2006
Last updated
03/22/2016
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