Provider Demographics
NPI:1497882922
Name:BAQUERO, JEAN MARIE (RD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:BAQUERO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 FOUR WYNDS TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1573
Mailing Address - Country:US
Mailing Address - Phone:859-272-8133
Mailing Address - Fax:
Practice Address - Street 1:1451 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3758
Practice Address - Country:US
Practice Address - Phone:859-977-4000
Practice Address - Fax:859-975-5100
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1152133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0925501Medicare ID - Type UnspecifiedPIN-MEDICARE