Provider Demographics
NPI:1366468605
Name:MANNING, WILLIAM D (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:MANNING
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-277-5887
Mailing Address - Fax:859-276-7638
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 601
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-277-5887
Practice Address - Fax:859-276-7638
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY970028830OtherRAILROAD MEDICARE
KY9500359600Medicaid
KY0212424Medicare PIN