Provider Demographics
NPI:1952292658
Name:FORD, IESHIA CHACHAREL DENISE
Entity type:Individual
Prefix:
First Name:IESHIA
Middle Name:CHACHAREL DENISE
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1191
Mailing Address - Country:US
Mailing Address - Phone:859-270-6971
Mailing Address - Fax:
Practice Address - Street 1:145 BURT RD STE 19
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2401
Practice Address - Country:US
Practice Address - Phone:859-270-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist