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General NPI Number Information
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NPI Number | 1649245440
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Entity Type | Individual
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Provider Name | EFFIE E LARY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 210 E GRAY ST STE 1105
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City | LOUISVILLE
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State | KY
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Zip | 40202-3907
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Country | US
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Telephone | 502-583-1697
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Fax | 919-385-9353
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Provider Business Mailing Address
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Address Line | 200 TRENT DR # 1B1C
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City | DURHAM
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State | NC
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Zip | 27710-8568
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Country | US
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Telephone | 919-684-7777
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Fax | 919-385-9353
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102536
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110007853
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | TC079
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License Number State | KY
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