Basic Information
| Provider Information | |||||||||
| NPI: | 1326594847 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAW | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4071 TATES CREEK CENTRE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405173062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599714695 | ||||||||
| FaxNumber: | 8599714604 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592760414 | ||||||||
| FaxNumber: | 8592763765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2016 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3010474 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.