Provider Demographics
NPI:1710926738
Name:BERNALES, NANNETTE E (MD)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:E
Last Name:BERNALES
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 1:1733 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3277
Mailing Address - Country:US
Mailing Address - Phone:859-278-4869
Mailing Address - Fax:859-296-0362
Practice Address - Street 1:1733 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3277
Practice Address - Country:US
Practice Address - Phone:859-278-4869
Practice Address - Fax:859-296-0362
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23610207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2332407Medicaid
KY64236102Medicaid
KY080105457OtherRAILROAD MEDICARE
OH2332407Medicaid
KY0398203Medicare PIN
KY64236102Medicaid