Healthcare Provider Details

I. General information

NPI: 1295274132
Provider Name (Legal Business Name): JENNIFER MAE CHEROLIS BSN,RN,CDE,MLDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CRASK CHEROLIS

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 125
LEXINGTON KY
40504-3504
US

IV. Provider business mailing address

830 S LIMESTONE UNIVERSITY HEALTH SERVICES BUILDING 4TH FLOOR, BARNSTABLE BROWN DIABETES CENTER
LEXINGTON KY
40536-0284
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2232
  • Fax: 859-257-0659
Mailing address:
  • Phone: 859-323-5407
  • Fax: 859-257-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1064122
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number131302
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: