Basic Information
Provider Information | |||||||||
NPI: | 1467418103 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JAMIE | ||||||||
FirstName: | WHITNEY | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 776351 | ||||||||
Address2: |   | ||||||||
City: | CHICAGO | ||||||||
State: | IL | ||||||||
PostalCode: | 606776351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5029696552 | ||||||||
FaxNumber: | 5022121358 | ||||||||
Practice Location | |||||||||
Address1: | 4121 DUTCHMANS LN | ||||||||
Address2: | SUITE 515 | ||||||||
City: | LOUISVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 402074707 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5028996907 | ||||||||
FaxNumber: | 5028996905 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/21/2006 | ||||||||
LastUpdateDate: | 11/01/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 39226 | KY | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
ID | Type | State | Issuer | Description | 0305488 | 01 |   | CIGNA / CMA DBA | OTHER | 64104227 | 05 | KY |   | MEDICAID | 000000379510 | 01 |   | ANTHEM / CMA DBA | OTHER | 1223618 | 01 |   | CHA / CMA DBA | OTHER | 50007178 | 01 |   | PASSPORT / CMA DBA | OTHER | 000023031Q | 01 |   | HUMANA / CMA DBA | OTHER | 200540690 | 05 | IN |   | MEDICAID | 2448350000 | 01 |   | PASSPORT ADVANTAGE / CMA DBA | OTHER | 061453 | 01 |   | SIHO / CMA DBA | OTHER |