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NPI Code Detail

MEDICARE: MRS. GRETCHEN B. CLIBURN PA-C

MEDICARE: MRS. GRETCHEN B. CLIBURN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA385KY

General Provider Information

NPI Number : 1043215536
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRETCHEN B. CLIBURN PA-C
Provider Business Mailing Address
First Line : 4071 TATES CREEK CENTRE DR STE 202
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-3094
Country : US
Telephone Number : 859-226-0206
Fax Number : 859-226-0207
Provider Business Practice Location Address
First Line : 4071 TATES CREEK CENTRE DR STE 202
Second Line :
City : LEXINGTON
State : KY
Zip : 40517-3094
Country : US
Telephone Number : 859-226-0206
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 01/09/2019

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