Provider Demographics
NPI:1538270988
Name:OLIVER, JENNIFER S (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 GENERAL JOHN PAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9168
Mailing Address - Country:US
Mailing Address - Phone:502-868-7488
Mailing Address - Fax:
Practice Address - Street 1:1162 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-863-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000195006OtherANTHEM
KY1200631OtherUNITED HEALTH CARE
KY64020456Medicaid
KYG58637Medicare UPIN
KY0317419Medicare ID - Type Unspecified