Provider Demographics
NPI:1962466680
Name:NERDERMAN, JOAN KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:KAY
Last Name:NERDERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MELBOURNE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2652
Mailing Address - Country:US
Mailing Address - Phone:614-563-0720
Mailing Address - Fax:859-554-8265
Practice Address - Street 1:989 GOVERNORS LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1173
Practice Address - Country:US
Practice Address - Phone:598-554-8265
Practice Address - Fax:859-309-9032
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2196152W00000X
OH3882152W00000X, 152W00000X
OHRN149369163W00000X
KY2196DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000117705OtherANTHEM
10223OtherCVC
OH1962466680Medicaid
KY1962466680Medicaid