Basic Information
| Provider Information | |||||||||
| NPI: | 1689990558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAISLEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 98 ELM ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470252048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125374999 | ||||||||
| FaxNumber: | 8125375710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2010 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RB0002X | 01087421A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Bariatric Medicine | 208000000X | 01087421A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD42001 | IA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 01087421A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.