Provider Demographics
NPI:1467824623
Name:KLEINMANN, TAIJHA R (PA-C)
Entity Type:Individual
Prefix:
First Name:TAIJHA
Middle Name:R
Last Name:KLEINMANN
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 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:14949 N US HIGHWAY 25 E
Practice Address - Street 2:STE. 6
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6285
Practice Address - Country:US
Practice Address - Phone:606-528-2160
Practice Address - Fax:606-528-2162
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01559923OtherRR MEDICARE
KY7100388950Medicaid
KYP01559923OtherRR MEDICARE