Provider Demographics
NPI:1083690317
Name:CUDDY, JANA SUE (PA C)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:SUE
Last Name:CUDDY
Suffix:
Gender:F
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 1:1055 DOVE RUN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502
Mailing Address - Country:US
Mailing Address - Phone:859-269-4668
Mailing Address - Fax:859-266-5577
Practice Address - Street 1:1055 DOVE RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502
Practice Address - Country:US
Practice Address - Phone:859-269-4668
Practice Address - Fax:859-266-5577
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA054363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000543Medicaid
KY0692931Medicare ID - Type Unspecified
KY95000543Medicaid
KY0693030Medicare ID - Type Unspecified
R38237Medicare UPIN