Basic Information
| Provider Information | |||||||||
| NPI: | 1265497499 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOWE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10512 MEETING ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | PROSPECT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 400597590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022764706 | ||||||||
| FaxNumber: | 5024343461 | ||||||||
| Practice Location | |||||||||
| Address1: | 10512 MEETING ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | PROSPECT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022764706 | ||||||||
| FaxNumber: | 5024343461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QB0002X | 34201 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine | 207Q00000X | 34201 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50027740 | 01 | KY | PASSPORT | OTHER | 021504 | 01 | SIHO - NICC | OTHER | 000000664907 | 01 | KY | ANTHEM BC/BS | OTHER | 64342017 | 05 | KY | MEDICAID | 000000381955 | 01 | KY | ANTHEM FOR NICC | OTHER | P00415228 | 01 | KY | RAILROAD MEDICARE | OTHER |