Basic Information
Provider Information | |||||||||
NPI: | 1013993740 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOPKINS | ||||||||
FirstName: | JENNIFER | ||||||||
MiddleName: | WRIGHT | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1080 | ||||||||
Address2: |   | ||||||||
City: | BURKESVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 427171080 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2708586655 | ||||||||
FaxNumber: | 2708584607 | ||||||||
Practice Location | |||||||||
Address1: | 301 PROFESSIONAL PARK DR | ||||||||
Address2: |   | ||||||||
City: | GLASGOW | ||||||||
State: | KY | ||||||||
PostalCode: | 421413487 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2706519696 | ||||||||
FaxNumber: | 2706518666 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/15/2005 | ||||||||
LastUpdateDate: | 09/09/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/09/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 38151 | KY | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 208000000X | 38151 | KY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 200386100 | 05 | IN |   | MEDICAID | 64054836 | 05 | KY |   | MEDICAID |