Provider Demographics
NPI:1346293826
Name:WERKMEISTER, KELLY J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:WERKMEISTER
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 1:187 FARRA DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-8764
Mailing Address - Country:US
Mailing Address - Phone:859-792-1766
Mailing Address - Fax:859-792-1793
Practice Address - Street 1:187 FARRA DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-8764
Practice Address - Country:US
Practice Address - Phone:859-792-1766
Practice Address - Fax:859-792-1793
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA088363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95000881Medicaid
KYS70324Medicare UPIN
KY0985702Medicare ID - Type Unspecified