Provider Demographics
NPI:1538104047
Name:SWEENEY, CORINNE A (PA-C)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:A
Last Name:SWEENEY
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 1:450 E NEW CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2619
Mailing Address - Country:US
Mailing Address - Phone:859-255-2532
Mailing Address - Fax:859-255-2984
Practice Address - Street 1:450 E NEW CIRCLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2619
Practice Address - Country:US
Practice Address - Phone:859-255-2532
Practice Address - Fax:859-255-2984
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA897363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0650721Medicare ID - Type Unspecified
0576422Medicare ID - Type Unspecified
Q66074Medicare UPIN
D976305Medicare ID - Type Unspecified