Basic Information
| Provider Information | |||||||||
| NPI: | 1457553737 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTSCH | ||||||||
| FirstName: | BRITNEY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 HOPKINSVILLE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423451124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703385777 | ||||||||
| FaxNumber: | 2703385765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1497 NASHVILLE ST | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422768850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707269568 | ||||||||
| FaxNumber: | 2707269570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01068403A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 49456 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7100439140 | 05 | KY | MEDICAID | 200989950 | 05 | IN | MEDICAID |