Individual
JENNA LEIGH DISMORE WRINKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1107 CROWN POINTE DR STE 107, ELIZABETHTOWN, KY 42701-7280
(270) 506-3300
(270) 506-2843
Mailing address
PO BOX 21890, BELFAST, ME 04915-4115
(502) 907-0356
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
01075865A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
47108
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000963791
ANTHEM PIN
—
01
—
005625439
UNITED HEALTHCARE PROVIDER ID NUMBER
—
01
—
1232438
WELLCARE OF KY PROVIDER ID NUMBER
KY
05
—
201317930
—
IN
01
—
2355628
CIGNA PROVIDER ID NUMBER
—
01
—
339847KYIP
AETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
KY
01
—
5661958
AETNA PIN
—
05
—
7100167720
—
KY
01
—
CS1612000141
CARESOURCE ID
—
01
—
P01590218
RAILROAD MEDICARE
KY
01
—
P01957674
RAILROAD MEDICARE
IN
Enumeration date
03/31/2010
Last updated
06/09/2022
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