Provider Demographics
NPI:1497850796
Name:SORNSON, BERNICE M (APRN)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:M
Last Name:SORNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BERNICE
Other - Middle Name:
Other - Last Name:EADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3085 LAKECREST CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1707
Mailing Address - Country:US
Mailing Address - Phone:859-258-8600
Mailing Address - Fax:859-258-8610
Practice Address - Street 1:3085 LAKECREST CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1707
Practice Address - Country:US
Practice Address - Phone:859-258-8600
Practice Address - Fax:859-258-8610
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002436363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCB5773OtherRR MEDICARE GROUP
KY78006525Medicaid
KY37903705OtherMEDICAID LAB GROUP
KY500019906OtherRR MEDICARE PIN
KY4000501OtherMEDICARE LAB GROUP
KY0169Medicare PIN
KY37903705OtherMEDICAID LAB GROUP
KY0623801Medicare ID - Type Unspecified