Jennifer Erin Secrest, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8399 Issued in KY

Practice address

200 Don Allen Rd
Louisville, KY 40207-3910

Phone

(502) 727-4974

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1033270657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10300 LINN STATION RD STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402233840",
            "telephone_number": "502-410-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DON ALLEN RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402073910",
            "telephone_number": "502-727-4974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SECREST",
        "first_name": "JENNIFER",
        "middle_name": "ERIN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010855A",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "8399",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "8399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200835020",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Sebastian, PHARMD
• Siby Sebastian, MD
• Chad Philip Secor, MD
• Rachel K Secor, APRN
• Tami Secor, MD
• Kelley Sedita
• Joanne Ruth Sedlock, CRNA
• Jacqueline Sedwick
• Janell Seeger, M.D.
• Jaime Alexandra Seelmeyer, M.ED, LPCC

• General Practice Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.