Healthcare Provider Details

I. General information

NPI: 1376245936
Provider Name (Legal Business Name): SCOTT KAUFMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N DIXIE AVE
ELIZABETHTOWN KY
42701-2503
US

IV. Provider business mailing address

2081 CLARK STATION RD
FISHERVILLE KY
40023-8720
US

V. Phone/Fax

Practice location:
  • Phone: 606-669-2677
  • Fax:
Mailing address:
  • Phone: 502-741-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTC377
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC377
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: