Healthcare Provider Details

I. General information

NPI: 1952402091
Provider Name (Legal Business Name): PEDIATRIC & ADOLESCENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 HARRODSBURG RD
LEXINGTON KY
40503-2747
US

IV. Provider business mailing address

3050 HARRODSBURG RD
LEXINGTON KY
40503-2747
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-6102
  • Fax: 859-977-0237
Mailing address:
  • Phone: 859-277-6102
  • Fax: 859-977-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BARNETT LEWIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 859-277-6102