Jessica K. Pack, MHA, MS, LGC

Primary specialty

Genetic Counselor (M.S.)Taxonomy code 170300000X

Practice address

4330 Glenview Avenue
#111
Glenview, KY 40025-0111

Phone

(888) 252-2842

Fax

(502) 470-3645

NPI assigned

Sep 23, 2011

Last updated

Apr 24, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1205119575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3139",
            "city": "CORYDON",
            "state": "IN",
            "postal_code": "471123139",
            "telephone_number": "888-252-2842",
            "fax_number": "502-470-3645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 GLENVIEW AVENUE",
            "address_2": "#111",
            "city": "GLENVIEW",
            "state": "KY",
            "postal_code": "400250111",
            "telephone_number": "888-252-2842",
            "fax_number": "502-470-3645"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "245 W Highway 62 Unit 3139",
            "address_purpose": "LOCATION",
            "city": "Corydon",
            "state": "IN",
            "postal_code": "471124552",
            "country_code": "US",
            "telephone_number": "888-252-2842 x700",
            "fax_number": "502-470-3645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACK",
        "first_name": "JESSICA",
        "middle_name": "K.",
        "credential": "MHA, MS, LGC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-23",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "170300000X",
            "taxonomy_group": "",
            "desc": "Genetic Counselor, MS",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENETIC COUNSELING LICENSE",
            "identifier": "96",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENETIC COUNSELING LICENSE",
            "identifier": "74000172A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.