Individual
ISMAEL CANDELARIO FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 EXECUTIVE PARK, LOUISVILLE, KY 40207-4201
(502) 855-7200
(502) 855-7201
Mailing address
513 WILLOWHURST PL, LOUISVILLE, KY 40223-3361
(602) 743-1607
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7101082600
—
KY
Enumeration date
02/10/2025
Last updated
09/23/2025
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