Healthcare Provider Details

I. General information

NPI: 1497401400
Provider Name (Legal Business Name): ANA M ZAPATA GONZALEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NATURE TRL STE 3
RADCLIFF KY
40160-9111
US

IV. Provider business mailing address

75 NATURE TRL STE 3
RADCLIFF KY
40160-9111
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-2323
  • Fax: 270-351-8031
Mailing address:
  • Phone: 270-351-2323
  • Fax: 270-351-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC307
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: