Provider Demographics
NPI:1356481121
Name:NARDUCCI, AUDREY ANN (M D)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ANN
Last Name:NARDUCCI
Suffix:
Gender:F
Credentials:M D
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:ANN
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1823
Mailing Address - Country:US
Mailing Address - Phone:859-239-1000
Mailing Address - Fax:
Practice Address - Street 1:110 METKER TRL
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1020
Practice Address - Country:US
Practice Address - Phone:606-365-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39020208600000X
OH3589806208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1218092OtherCHA
IN01043288OtherLICENSE
IN100468550AMedicaid
OH2764521Medicaid
KY64094220Medicaid
KY351942907OtherHUMANA
KY39020OtherLICENSE
KY000000090713OtherBLUE CROSS BLUE SHIELD
KY351942907OtherBLUE GRASS FAMILY HEALTH
OHNA6035721Medicare PIN
KY1218092OtherCHA
KY39020OtherLICENSE
KY1960301Medicare ID - Type Unspecified
F92361Medicare UPIN