Provider Demographics
NPI:1164534152
Name:YOUNT, SUZANNE KELLY (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KELLY
Last Name:YOUNT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U.S. HWY 25 SOUTH
Mailing Address - Street 2:PO BOX 750
Mailing Address - City:LILY
Mailing Address - State:KY
Mailing Address - Zip Code:40740
Mailing Address - Country:US
Mailing Address - Phone:606-523-1660
Mailing Address - Fax:606-523-1665
Practice Address - Street 1:U.S. HWY 25 SOUTH
Practice Address - Street 2:U.S. HWY 25 SOUTH
Practice Address - City:LILY
Practice Address - State:KY
Practice Address - Zip Code:40740
Practice Address - Country:US
Practice Address - Phone:606-523-1660
Practice Address - Fax:606-523-1665
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA180363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000516118OtherBCBS-EBMC
KY000000516142OtherBCBS-LCMC
KY000000517349OtherBCBS-BSMC
KY000000516186OtherBCBS-AMC
KY0374012Medicare PIN
KY0076916Medicare PIN
KY0230814Medicare PIN
KY000000516118OtherBCBS-EBMC
KYOTH000Medicare UPIN
KY0736408Medicare PIN