Provider Demographics
NPI:1760603708
Name:SAXON, LYNN R (PA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:R
Last Name:SAXON
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5064
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:9300 STONESTREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2863
Practice Address - Country:US
Practice Address - Phone:502-935-8061
Practice Address - Fax:502-933-7010
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA289363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100112800Medicaid
KYK095990OtherMEDICARE PTAN - NLSC-RCO
KYP00805576Medicare PIN
KY7100112800Medicaid