Provider Demographics
NPI:1588294136
Name:VARNEY, JAIME ISON (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ISON
Last Name:VARNEY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ISON
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 CHAMPION WAY STE 7
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8861
Mailing Address - Country:US
Mailing Address - Phone:859-317-0802
Mailing Address - Fax:
Practice Address - Street 1:203 CHAMPION WAY STE 7
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8861
Practice Address - Country:US
Practice Address - Phone:270-225-4033
Practice Address - Fax:270-295-9054
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4023408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid