1295274132 NPI number — MRS. JENNIFER MAE CHEROLIS BSN,RN,CDE,MLDE

Table of content: MRS. JENNIFER MAE CHEROLIS BSN,RN,CDE,MLDE (NPI 1295274132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295274132 NPI number — MRS. JENNIFER MAE CHEROLIS BSN,RN,CDE,MLDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEROLIS
Provider First Name:
JENNIFER
Provider Middle Name:
MAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSN,RN,CDE,MLDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHEROLIS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
CRASK
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295274132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 S LIMESTONE UNIVERSITY HEALTH SERVICES BUILDING
Provider Second Line Business Mailing Address:
4TH FLOOR, BARNSTABLE BROWN DIABETES CENTER
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-5407
Provider Business Mailing Address Fax Number:
859-257-0487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2195 HARRODSBURG RD STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-2232
Provider Business Practice Location Address Fax Number:
859-257-0659
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  1064122 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WD0400X , with the licence number: 131302 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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