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2923 Virginia Ave Louisville KY 40211-3420 | |
| (502) 936-0222 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2923 Virginia Ave, Louisville, Kentucky |
| Authorized Official Name and Position | Janessa James (OWNER) |
| Authorized Official Contact | 5029360222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1016 Senate Ave Jeffersonville IN 47130-5760 Ph: (502) 936-0222 | 2923 Virginia Ave Louisville KY 40211-3420 Ph: (502) 936-0222 |
| NPI Number | 1871335620 |
|---|---|
| Provider Enumeration Date | 06/12/2024 |
| Last Update Date | 12/08/2024 |
| Certification Date | 12/08/2024 |
| Medicare PECOS PAC ID | 2668918608 |
|---|---|
| Medicare Enrollment ID | O20240725003205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871335620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
| Provider Name | Janessa Marie James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275388696 PECOS PAC ID: 9537603329 Enrollment ID: I20240703003283 |
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