Provider Demographics
NPI:1598395212
Name:EADS, MOLLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:EADS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:LEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3085 LAKECREST CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1707
Mailing Address - Country:US
Mailing Address - Phone:859-258-8600
Mailing Address - Fax:
Practice Address - Street 1:3085 LAKECREST CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1707
Practice Address - Country:US
Practice Address - Phone:859-258-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant