Healthcare Provider Details

I. General information

NPI: 1578933883
Provider Name (Legal Business Name): JOHN WILLIAM BIERY JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE D200
LEXINGTON KY
40536-3409
US

IV. Provider business mailing address

2300 CHAMBER CENTER DR SUITE 200
LAKESIDE PARK KY
41017-1686
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6700
  • Fax: 859-257-1331
Mailing address:
  • Phone: 859-341-3575
  • Fax: 859-341-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009777
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3009777
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: