MR. JONATHON LEE ENNIS (NPI# 1497267637) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497267637 |
| Entity Type | Individual |
| Full Name | MR. JONATHON LEE ENNIS |
| Credential | PAC |
| Practice Address |
805 Bardstown Rd Springfield KY 40069 |
| Mailing Address |
805 Bardstown Rd Springfield KY 40069-1513 |
| Practice Telephone | 8594817113 |
| Practice Fax Number | 8594817114 |
| Mailing Telephone | 8594817113 |
| Mailing Fax Number | 8594817114 |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2019-03-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | KY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100515140 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 Tates Dr, Springfield, KY 400691598 | 5025070976 | |
| 120 Executive Park, Louisville, KY 402074201 | 5028557200 |
| Street Address |
805 BARDSTOWN RD |
| City | SPRINGFIELD |
| State | KY |
| Zip Code | 40069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497123731 | Millie Lynn Smith | Pharmacist | 805 Bardstown Rd, Suite 1, Springfield, KY 40069-1513 | 2015-09-03 |
| 1154773992 | Allie Lynn Perkins | Pharmacist | 805 Bardstown Rd, Suite 1, Springfield, KY 40069-1513 | 2016-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972901189 | Fred's Stores of Tennessee Inc | Pharmacy | 1117 Lincoln Park Rd, Springfield, KY 40069 | 2014-12-22 |
| 1730455346 | Christina Nicole Saunier | Speech-Language Pathologist | 716 East Grundy Ave, Springfield, KY 40069 | 2012-03-28 |
| 1912157207 | Allison Brooke Ballard | Social Worker | 2373 Lincoln Park Rd, Springfield, KY 40069 | 2008-09-24 |
| 1497737001 | Lincoln Trail District Health Dept | Public Health or Welfare | 302 E Main St, Springfield, KY 40069 | 2005-11-18 |
| 1619496395 | Family Wellcare Clinic, Pllc | Internal Medicine | 805 Bardstown Rd Ste 12, Springfield, KY 40069 | 2017-09-14 |
| 1750562690 | Washington County Schools | Local Education Agency (LEA) | 120 Mackville Hl, Springfield, KY 40069-1013 | 2007-11-20 |
| 1912028309 | Colette M Hill | Massage Therapist | 114 S Walnut St, Springfield, KY 40069-1104 | 2007-04-03 |
| 1083751424 | Communicare Inc | Community/Behavioral Health | 324 E Main St, Springfield, KY 40069-1127 | 2007-02-01 |
| 1639654809 | Bardstown Primary Care, Pllc | Clinic/Center | 102 W Depot St, Springfield, KY 40069-1159 | 2018-10-03 |
| 1376617837 | Extendicare Homes, Inc. | Skilled Nursing Facility | 420 E Grundy Ave, Springfield, KY 40069-1173 | 2006-11-17 |
| Find all providers in zip 40069 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123289 | Jared Anthony Dias | Physician Assistant | 52 Devens St, Springfield, MA 01151-2304 | 2020-04-16 |
| 1659990976 | Maham Siddiqui | Physician Assistant | 8632 Hillside Manor Dr, Springfield, VA 22152-2238 | 2020-04-16 |
| 1558994772 | Kayla Rice | Physician Assistant | 3640 Main St Ste 103, Springfield, MA 01107-1139 | 2020-02-17 |
| 1487286563 | Michayla Marcil | Physician Assistant | 280 Chestnut St Fl 2, Springfield, MA 01199-1001 | 2020-02-06 |
| 1508416140 | Chase Michael Collings | Physician Assistant | 960 N 16th St Ste 303, Springfield, OR 97477 | 2019-09-16 |
| 1023670593 | Michael Peter Lembotesis | Physician Assistant | 629 Evans Rd, Springfield, PA 19064-3033 | 2019-07-03 |
| 1245795558 | Alexandra Marie Cutler | Physician Assistant | 1437 S Gelven Ave, Springfield, MO 65804-2124 | 2019-01-31 |
| 1598265894 | Kelsey L. Magill | Physician Assistant | 3231 S National Ave Ste 440, Springfield, MO 65807-7304 | 2018-02-14 |
| 1447759592 | Darrell Dewain Edwards | Physician Assistant | 4350 S National Ave Ste C200, Springfield, MO 65810-2782 | 2018-02-05 |
| 1164930087 | Ashley Jean Nichole Leutze | Physician Assistant | 1164 E Home Rd Ste J, Springfield, OH 45503-2726 | 2018-01-12 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 40069 |
Please comment or provide details below to improve the information on MR. JONATHON LEE ENNIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.