Provider Demographics
NPI:1417478157
Name:SERGENT BOURNE, CHANDRE (APRN)
Entity Type:Individual
Prefix:
First Name:CHANDRE
Middle Name:
Last Name:SERGENT BOURNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ACE DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1327
Mailing Address - Country:US
Mailing Address - Phone:859-756-5006
Mailing Address - Fax:859-756-5006
Practice Address - Street 1:1000 ACE DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1327
Practice Address - Country:US
Practice Address - Phone:859-756-5006
Practice Address - Fax:859-985-9665
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily