Individual
JESSICA ANNE WYNKOOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5505 PHOENIX HILL CT, LOUISVILLE, KY 40207-1216
(502) 415-1300
Mailing address
5505 PHOENIX HILL CT, LOUISVILLE, KY 40207-1216
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/08/2019
Last updated
08/30/2022
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