Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5629P | KY |
NPI | 1023270568 |
---|---|
Provider Name | Bhavini Bharat Mody |
First Address | Lexington, KY 40503-1827 |
Second Address | Lexington, KY 40503-1827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 22/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100047050 | (05) | KY |