Provider Demographics
NPI:1639402316
Name:BRATCHER, JENNA (APRN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BRATCHER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:KY
Mailing Address - Zip Code:42726-7048
Mailing Address - Country:US
Mailing Address - Phone:270-971-1231
Mailing Address - Fax:270-971-1411
Practice Address - Street 1:722 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:KY
Practice Address - Zip Code:42726-7048
Practice Address - Country:US
Practice Address - Phone:270-971-1231
Practice Address - Fax:270-971-1411
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006163363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100089410Medicaid