Provider Demographics
NPI:1093756355
Name:TALUSKIE, STACY M (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:TALUSKIE
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 1:101 MEDICAL HEIGHTS DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4137
Mailing Address - Country:US
Mailing Address - Phone:502-227-7538
Mailing Address - Fax:502-227-9248
Practice Address - Street 1:101 MEDICAL HEIGHTS DR
Practice Address - Street 2:SUITE M
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4137
Practice Address - Country:US
Practice Address - Phone:502-227-7538
Practice Address - Fax:502-227-9248
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA703363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005260Medicaid
KY000000352734OtherANTHEM
KYC30629OtherRAILROAD MEDICARE
KY0212208Medicare PIN
KY8023Medicare PIN
KY95005260Medicaid