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Individual

MRS. JENNIFER RUTH STREET

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, PA-C, ATC

Contact information

Practice address
201 ABRAHAM FLEXNER WAY STE 100, LOUISVILLE, KY 40202-3841
(502) 587-8222
(502) 587-0160
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2311
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300047016
IN
05
7100491200
KY
Enumeration date
08/28/2008
Last updated
11/06/2023
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