Active NPI
Jenny M. Petrie, PH.D.
- Clinical Psychologist
- Louisville, KY
National Provider Identifier
1356754733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 171261
- Practice address
- 11730 Old Shelbyville Rd
Louisville, KY 40243-1482 - Phone
- (502) 883-4073
- Fax
- (502) 883-4139
- NPI assigned
- Jun 3, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 171261 | KY | Primary |
Addresses
Primary practice location
11730 Old Shelbyville Rd
Louisville, KY 40243-1482
Mailing address
11730 Old Shelbyville Rd
Louisville, KY 40243-1482
Phone (502) 883-4073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2025 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1356754733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11730 OLD SHELBYVILLE RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402431482",
"telephone_number": "502-883-4073",
"fax_number": "502-883-4139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11730 OLD SHELBYVILLE RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402431482",
"telephone_number": "502-883-4073",
"fax_number": "502-883-4139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRIE",
"first_name": "JENNY",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-03",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "171261",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.