MEDICARE: RITA MARIE PAXSON ARNP

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
1	363LC0200X	Critical Care Medicine Nurse Practitioner	1036392	KY
2	363LF0000X	Family Nurse Practitioner	3004097	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000309461	OTHER	KY	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194731919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA MARIE PAXSON ARNP

Provider Business Mailing Address
First Line	:	166 PASADENA DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2973
Country	:	US
Telephone Number	:	859-278-0319
Fax Number	:	859-277-9699

Provider Business Practice Location Address
First Line	:	3101 RICHMOND RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1599
Country	:	US
Telephone Number	:	859-268-9866
Fax Number	:	859-268-0458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/30/2014

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