Provider Demographics
NPI:1669686010
Name:LAVELLE, JAMES MICHAEL (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:LAVELLE
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:810 BELLEFONTE PRINCESS RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2272
Mailing Address - Country:US
Mailing Address - Phone:606-921-6805
Mailing Address - Fax:606-921-6332
Practice Address - Street 1:810 BELLEFONTE PRINCESS RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2272
Practice Address - Country:US
Practice Address - Phone:606-921-6805
Practice Address - Fax:606-921-6332
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
KYKY 537363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical