Provider Demographics
NPI:1528438124
Name:BEAR, MINA (APRN-NP)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:BEAR
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-968-6226
Mailing Address - Fax:502-966-5562
Practice Address - Street 1:5100 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-4056
Practice Address - Country:US
Practice Address - Phone:502-968-6226
Practice Address - Fax:502-966-5562
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100365200Medicaid
KYK192711Medicare PIN