Healthcare Provider Details

I. General information

NPI: 1366468605
Provider Name (Legal Business Name): WILLIAM D MANNING PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE L304
LEXINGTON KY
40536-1404
US

IV. Provider business mailing address

1720 NICHOLASVILLE RD SUITE 601
LEXINGTON KY
40503-1404
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6494
  • Fax: 859-257-2573
Mailing address:
  • Phone: 859-277-5887
  • Fax: 859-276-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA359
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA359
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA359
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: