Provider Demographics
NPI:1801134192
Name:SCHNABEL, BRYAN
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:SCHNABEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 IVYBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1176
Mailing Address - Country:US
Mailing Address - Phone:859-421-3682
Mailing Address - Fax:859-245-4681
Practice Address - Street 1:5060 IVYBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1176
Practice Address - Country:US
Practice Address - Phone:859-421-3682
Practice Address - Fax:859-245-4681
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004211174400000X
KY1101890363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty