Healthcare Provider Details

I. General information

NPI: 1205162252
Provider Name (Legal Business Name): LUCAS J KENNEDY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK DIVISION OF DIGESTIVE DISEASES 740 S. LIMESTONE, 2ND FLOOR
LEXINGTON KY
40536-0284
US

IV. Provider business mailing address

UK DIVISION OF DIGESTIVE DISEASES 800 ROSE STREET, MN649
LEXINGTON KY
40536-0298
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0079
  • Fax: 859-257-9287
Mailing address:
  • Phone: 859-323-4887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1219
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1219
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1219
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: