Basic Information
| Provider Information | |||||||||
| NPI: | 1356481121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NARDUCCI | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M. D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PERRY | ||||||||
| OtherFirstName: | AUDREY | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 217 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404221823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592391000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 METKER TRL | ||||||||
| Address2: | |||||||||
| City: | STANFORD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404841020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063653360 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 39020 | KY | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 3589806 | OH | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1218092 | 01 | KY | CHA | OTHER | 01043288 | 01 | IN | LICENSE | OTHER | 100468550A | 05 | IN | MEDICAID | 2764521 | 05 | OH | MEDICAID | 64094220 | 05 | KY | MEDICAID | 351942907 | 01 | KY | HUMANA | OTHER | 39020 | 01 | KY | LICENSE | OTHER | 000000090713 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | 351942907 | 01 | KY | BLUE GRASS FAMILY HEALTH | OTHER |