Provider Demographics
NPI:1417017450
Name:BERNARD, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MD
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:601 S FLOYD ST STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1837
Practice Address - Country:US
Practice Address - Phone:502-629-1515
Practice Address - Fax:502-629-1545
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58709207V00000X
KY44072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50034768OtherPASSPORT- WOMEN'S SPECIALISTS
KYP01034545OtherRAILROAD MEDICARE KY- WOMEN'S SPECIALISTS
KY50034768OtherPASSPORT- WOMEN'S SPECIALISTS
KYP01034545OtherRAILROAD MEDICARE KY- WOMEN'S SPECIALISTS
S883F919Medicare ID - Type Unspecified
MDK679I411Medicare ID - Type Unspecified