Provider Demographics
NPI:1699881730
Name:JAMISON, KATHERINE LEEANN (ARNP, RN)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LEEANN
Last Name:JAMISON
Suffix:
Gender:F
Credentials:ARNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DUDLEY PIKE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2372
Mailing Address - Country:US
Mailing Address - Phone:859-630-5851
Mailing Address - Fax:
Practice Address - Street 1:1700 DECLARATION DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8441
Practice Address - Country:US
Practice Address - Phone:859-898-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3174P363LF0000X
KY3003174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208663Medicaid
KYQ72422Medicare UPIN
KY1042209Medicare PIN