MEDICARE: FARRAH J CONN 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
1	363A00000X	Physician Assistant	PA663	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0693523	OTHER	KY	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1801926845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH J CONN PA-C

Provider Business Mailing Address
First Line	:	113 AUTUMN RIDGE DR
Second Line	:
City	:	MT STERLING
State	:	KY
Zip	:	40353-1646
Country	:	US
Telephone Number	:	859-585-5022
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 AUTUMN RIDGE DR
Second Line	:
City	:	MT STERLING
State	:	KY
Zip	:	40353-1646
Country	:	US
Telephone Number	:	859-585-5022
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/16/2011

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Directions to “ FARRAH J CONN PA-C” Practice Location

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