1356481121 NPI number — DR. AUDREY ANN NARDUCCI M. D.

Table of content: DR. ROBERT M VERKLIN JR. MD (NPI 1144223736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356481121 NPI number — DR. AUDREY ANN NARDUCCI M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NARDUCCI
Provider First Name:
AUDREY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
AUDREY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356481121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 S 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-239-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 METKER TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40484-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-365-3360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

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: 208600000X , with the licence number:  39020 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 3589806 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1218092 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 100468550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351942907 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000090713 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 39020 . This is a "LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01043288 . This is a "LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2764521 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 351942907 . This is a "BLUE GRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64094220 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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