Provider Demographics
NPI:1487698957
Name:BERNARD, WINDY LESTER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:WINDY
Middle Name:LESTER
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:WINDY
Other - Middle Name:SUE
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3157
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3157
Mailing Address - Country:US
Mailing Address - Phone:770-985-8899
Mailing Address - Fax:
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:STE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:770-405-2976
Practice Address - Fax:770-988-0730
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004722363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA162177349AMedicaid
SC0429PAMedicaid
GAP00372925OtherRR MEDICARE
GA97WCHJRMedicare PIN
Q64956Medicare UPIN