Dr. Jerry W Brackett
General Practice Physician
607 Chestnut St
Berea
, Kentucky 40403-1514
Dr. Jerry W Brackett
General Practice Physician
607 Chestnut St
Berea
, Kentucky 40403-1514
(606) 789-5600
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About
Features
Specialties
- General Practice Physician
Languages spoken
- English
Location
First Address
- Dr. Jerry W Brackett
- 607 Chestnut St
- Berea, KY
- Zip : 40403-1514
- Fax : (606) 789-5600
- Phone : (859) 582-9331
Second Address
- Dr. Jerry W Brackett
- 607 Chestnut St
- Berea, KY
- Zip : 40403-1514
- Fax : (606) 789-5600
- Phone : (859) 582-9331
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208D00000X | General Practice Physician | 14390 | KY |
National Provider Identifier
| NPI | 1033165394 |
|---|---|
| Provider Name | Dr. Jerry W Brackett |
| First Address | Berea, KY 40403-1514 |
| Second Address | Berea, KY 40403-1514 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 26/05/2006 |
| Last Update Date | 15/06/2009 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000059655 | ANTHEM (01) | KY |
| 1469901 | (02) | KY |
| 340002395 | RAILROAD MEDICARE (01) | KY |
| 611139169 | HUMANA (01) | KY |
| 64143902 | (05) | KY |
| B48107 | (02) | KY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.