Individual
NICOLE MARIE CLEMENTS JODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2933 BRECKENRIDGE LN STE 102, LOUISVILLE, KY 40220-1494
(502) 588-9588
(502) 588-0554
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 559-9411
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R76837
AZ
207W00000X
Ophthalmology Physician
59604
KY
207W00000X
Ophthalmology Physician
A179129
CA
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
59604
KY
Other
Enumeration date
05/22/2018
Last updated
07/31/2024
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