Provider Demographics
NPI:1003142852
Name:ATKINS, DAVID C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:ATKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 LAKECREST CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1707
Mailing Address - Country:US
Mailing Address - Phone:859-258-8600
Mailing Address - Fax:859-258-8610
Practice Address - Street 1:3085 LAKECREST CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1707
Practice Address - Country:US
Practice Address - Phone:859-258-8600
Practice Address - Fax:859-258-8610
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1332363A00000X
KYTC055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTC055OtherKY PA LICENSE