Provider Demographics
NPI:1346390820
Name:ALLEN, KATHRYN CARTER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:CARTER
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2101 NICHOLASVILLE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2526
Mailing Address - Country:US
Mailing Address - Phone:859-277-5771
Mailing Address - Fax:859-276-4622
Practice Address - Street 1:2101 NICHOLASVILLE RD STE 304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2526
Practice Address - Country:US
Practice Address - Phone:859-277-5771
Practice Address - Fax:859-276-4622
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KYPA 1025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000581022OtherANTHEM PIN
KY9124408OtherAETNA PIN
KY9124408OtherAETNA PIN
KY000000581022OtherANTHEM PIN
KYK039330Medicare PIN
KY00570Medicare PIN