Provider Demographics
NPI:1023270568
Name:MODY-HIGH, BHAVINI BHARAT (APRN)
Entity type:Individual
Prefix:
First Name:BHAVINI
Middle Name:BHARAT
Last Name:MODY-HIGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BHAVINI
Other - Middle Name:BHARAT
Other - Last Name:MODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2392
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:496 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1827
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-288-7510
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005629363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100047050Medicaid
KYK025430Medicare PIN
KY0037697Medicare PIN