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NPI Code Detail

MEDICARE: DESHANA A. COLLETT PA-C

MEDICARE:   DESHANA A. COLLETT  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
1363AM0700XMedical Physician AssistantPA845KY
2363A00000XPhysician AssistantPA845KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336233998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESHANA A. COLLETT PA-C
Provider Business Mailing Address
First Line : 989 GOVERNORS LN STE 240
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1175
Country : US
Telephone Number : 859-338-3958
Fax Number : 859-368-8135
Provider Business Practice Location Address
First Line : 989 GOVERNORS LN STE 240
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1175
Country : US
Telephone Number : 859-338-3958
Fax Number : 859-368-8135
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/22/2024

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Directions to “ DESHANA A. COLLETT PA-C” Practice Location

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