Basic Information
| Provider Information | |||||||||
| NPI: | 1730508128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAXTON-BROWN | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 THOMAS MORE PKWY | ||||||||
| Address2: | CHAPEL PLACE B STE 220 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593012211 | ||||||||
| FaxNumber: | 8593012511 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL VILLAGE DR | ||||||||
| Address2: | STE 258 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593012211 | ||||||||
| FaxNumber: | 8593012511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2014 | ||||||||
| LastUpdateDate: | 11/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 366887 | OH | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 3010601 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 1117832 | KY | N | Nursing Service Providers | Registered Nurse |
No ID Information.