Provider Demographics
NPI:1629313010
Name:RATCLIFF, TESHLA RAE (PA)
Entity Type:Individual
Prefix:
First Name:TESHLA
Middle Name:RAE
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 DUTCHMANS LN STE 4A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4745
Mailing Address - Country:US
Mailing Address - Phone:502-365-2655
Mailing Address - Fax:502-365-2770
Practice Address - Street 1:3999 DUTCHMANS LN STE 4A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4745
Practice Address - Country:US
Practice Address - Phone:502-365-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant