Provider Demographics
NPI:1083616064
Name:DELLAY, DEBRA (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DELLAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2915
Mailing Address - Country:US
Mailing Address - Phone:859-221-5259
Mailing Address - Fax:
Practice Address - Street 1:989 GOVERNORS LN,
Practice Address - Street 2:STE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1175
Practice Address - Country:US
Practice Address - Phone:859-338-3958
Practice Address - Fax:859-368-8135
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003069363LA2100X
KY3069P363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS92405Medicare UPIN
KY0234511Medicare ID - Type Unspecified