Basic Information
Provider Information
NPI: 1629052303
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STUDTS
FirstName: JAMIE
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1301 COOPER DR
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405022411
CountryCode: US
TelephoneNumber: 8593230895
FaxNumber: 8593235350
Practice Location
Address1: 529 S JACKSON ST
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402023229
CountryCode: US
TelephoneNumber: 5025624370
FaxNumber: 5025624373
Other Information
ProviderEnumerationDate: 12/06/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000XKY1297KYY Behavioral Health & Social Service ProvidersPsychologist 

ID Information
IDTypeStateIssuerDescription
890005580005KY MEDICAID


Home