Individual provider Active NPI

Jamie A. Wathen

  • Clinical Social Worker
  • Elizabethtown, KY
National Provider Identifier
1417768060
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
257000 Issued in KY
Practice address
107 Cranes Roost CT
Elizabethtown, KY 42701-3650
Phone
(270) 765-2605
NPI assigned
Jan 14, 2025
Last updated
Jan 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 257000 KY Primary

Addresses

Primary practice location

107 Cranes Roost CT
Elizabethtown, KY 42701-3650

Mailing address

207B Fairgrounds Rd
Hardinsburg, KY 40143-2585

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251216003391 IN Practitioner - Clinical Social Worker 8921593021 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespring, IncGroup PAC ID 5294624508, 65 clinicians

Practice addresses (Care Compare)

535 Country Club Serd
Corydon, IN 47112-1705
Phone (812) 738-2114

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
257000KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespring, Inc CurrentSince Dec 1, 2025 Accepting new patients
Lifespring, Inc CurrentSince Dec 1, 2025 Accepting new patients

Locations

535 Country Club Rd SE
Corydon, IN 47112
Phone (812) 738-2114

1036 Sharon Dr
Jeffersonvlle, IN 47130
Phone (812) 258-9281

460 Spring St
Jeffersonvlle, IN 47130
Phone (812) 280-3583

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1736812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1417768060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207B FAIRGROUNDS RD",
            "city": "HARDINSBURG",
            "state": "KY",
            "postal_code": "401432585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 CRANES ROOST CT",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427013650",
            "telephone_number": "270-765-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATHEN",
        "first_name": "JAMIE",
        "middle_name": "A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-14",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "257000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

Verify at the official NPI Registry.