Provider Demographics
NPI:1326106873
Name:LIDDINGTON, JACQUELYNN ANNE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYNN
Middle Name:ANNE
Last Name:LIDDINGTON
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:2280 CHERRY SPRING RD
Mailing Address - Street 2:
Mailing Address - City:CUB RUN
Mailing Address - State:KY
Mailing Address - Zip Code:42729-8629
Mailing Address - Country:US
Mailing Address - Phone:270-524-4257
Mailing Address - Fax:270-982-9222
Practice Address - Street 1:1239 WOODLAND DR STE 105
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2770
Practice Address - Country:US
Practice Address - Phone:270-765-7676
Practice Address - Fax:270-982-9222
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA147363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical