MEDICARE: JENNIFER BROCATO ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3008873	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3008873	OTHER	KY	LICENSE

General Provider Information

NPI Number	:	1548644438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BROCATO ARNP

Provider Business Mailing Address
First Line	:	496 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1827
Country	:	US
Telephone Number	:	592-882-4258
Fax Number	:	859-288-7510

Provider Business Practice Location Address
First Line	:	1401 HARRODSBURG RD STE B165
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-1726
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-288-7510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	11/15/2023

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