Provider Demographics
NPI:1124202825
Name:OWENS, DANELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:
Last Name:OWENS
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 1:3475 RICHMOND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2500
Mailing Address - Country:US
Mailing Address - Phone:859-296-4400
Mailing Address - Fax:859-296-4300
Practice Address - Street 1:3475 RICHMOND RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2500
Practice Address - Country:US
Practice Address - Phone:859-296-4400
Practice Address - Fax:859-296-4300
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
7994Medicare UPIN