Provider Demographics
NPI:1194766253
Name:JENNINGS, SHAUN F (DO)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:F
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1686
Mailing Address - Country:US
Mailing Address - Phone:859-384-2660
Mailing Address - Fax:859-384-5248
Practice Address - Street 1:8726 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-9625
Practice Address - Country:US
Practice Address - Phone:859-384-2660
Practice Address - Fax:859-384-5248
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY02882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00217671OtherRAILROAD MEDICARE
KYP00873389OtherRAILROAD MEDICARE
KY64100167Medicaid
OH2600528Medicaid
OH2600528Medicaid
KYP00873389OtherRAILROAD MEDICARE
KYP00217671OtherRAILROAD MEDICARE