Provider Demographics
NPI:1558677898
Name:TUDOR, RACHEL L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:L
Last Name:TUDOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:LOUISE
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3409 DERBY LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1171
Mailing Address - Country:US
Mailing Address - Phone:517-515-9462
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3742
Practice Address - Country:US
Practice Address - Phone:859-313-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1578146D00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant