Provider Demographics
NPI:1083874788
Name:DARNELL, JEROD PRESTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROD
Middle Name:PRESTON
Last Name:DARNELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:1000 ASHLAND DR STE 302
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7003
Practice Address - Country:US
Practice Address - Phone:606-327-5454
Practice Address - Fax:606-327-2776
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00335213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00659814OtherRAILROAD
OH2927739Medicaid
KY7100064680Medicaid
OH2927739Medicaid