Healthcare Provider Details

I. General information

NPI: 1699770503
Provider Name (Legal Business Name): DEBORAH A CROUCHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE B485
LEXINGTON KY
40504-3797
US

IV. Provider business mailing address

230 LEXINGTON GREEN CIR STE 600
LEXINGTON KY
40503-3326
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-6143
  • Fax: 859-277-8659
Mailing address:
  • Phone: 859-971-4695
  • Fax: 859-971-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: