Provider Demographics
NPI:1609246156
Name:GASSER, ELIZABETH MANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MANN
Last Name:GASSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:JOHANNA
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-363-0588
Mailing Address - Fax:502-363-0972
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-363-0588
Practice Address - Fax:502-363-0972
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100439500Medicaid
KYK190871Medicare PIN