Provider Demographics
NPI:1760517742
Name:MARKERT, D'ANN B (PAC)
Entity Type:Individual
Prefix:MRS
First Name:D'ANN
Middle Name:B
Last Name:MARKERT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 BROWNS LN
Mailing Address - Street 2:STE. 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1500
Mailing Address - Country:US
Mailing Address - Phone:502-451-9296
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:4119 BROWNS LN
Practice Address - Street 2:STE. 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1500
Practice Address - Country:US
Practice Address - Phone:502-451-9296
Practice Address - Fax:502-451-9291
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA301363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP03754Medicare UPIN
KY0688702Medicare ID - Type Unspecified