Provider Demographics
NPI:1164696852
Name:CLAXON, AMY LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEIGH
Last Name:CLAXON
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 1:141 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1832
Mailing Address - Country:US
Mailing Address - Phone:859-277-5736
Mailing Address - Fax:
Practice Address - Street 1:141 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1832
Practice Address - Country:US
Practice Address - Phone:859-277-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant