Organization
BARDSTOWN DERMATOLOGY PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE CHESER (OFFICE MANAGER)
(502) 349-9999
Entity
Organization
Contact information
Practice address
114 MANOR DR, BARDSTOWN, KY 40004-3230
(502) 349-9999
(502) 349-9499
Mailing address
114 MANOR DR, BARDSTOWN, KY 40004-3230
(502) 349-9999
(502) 349-9499
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1135703
PASSPORT
KY
05
—
65934416
—
KY
01
—
9809
MEDICARE
KY
Enumeration date
12/13/2006
Last updated
01/17/2019
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