Individual
DR. JERRY W BRACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
607 CHESTNUT ST, BEREA, KY 40403-1514
(859) 582-9331
(606) 789-5600
Mailing address
607 CHESTNUT ST, BEREA, KY 40403-1514
(859) 582-9331
(606) 789-5600
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
14390
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000059655
ANTHEM
KY
01
—
340002395
RAILROAD MEDICARE
KY
01
—
611139169
HUMANA
KY
05
—
64143902
—
KY
Enumeration date
05/26/2006
Last updated
06/15/2009
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