Provider Demographics
NPI:1417044215
Name:GAYHEART, REBECCA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:GAYHEART
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:
Practice Address - Street 1:3581 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1140
Practice Address - Country:US
Practice Address - Phone:859-313-6200
Practice Address - Fax:859-447-8936
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA451363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY36000818OtherASC MEDICAID GROUP
KY37903705OtherMEDICAID LAB GROUP
KY970018782OtherRR MEDICARE PIN NO
KYASC1019OtherASC MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY95001657Medicaid
KY37903705OtherMEDICAID LAB GROUP
KY36000818OtherASC MEDICAID GROUP