Provider Demographics
NPI:1740024140
Name:BORDIGONI, MARIO (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:BORDIGONI
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 NICHOLASVILLE RD APT 51008
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-6356
Mailing Address - Country:US
Mailing Address - Phone:859-358-2378
Mailing Address - Fax:
Practice Address - Street 1:3800 NICHOLASVILLE RD APT 51008
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-6356
Practice Address - Country:US
Practice Address - Phone:859-358-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4023609363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health