Provider Demographics
NPI:1790713667
Name:ARTHUR, LITICIA R (PA-C)
Entity Type:Individual
Prefix:
First Name:LITICIA
Middle Name:R
Last Name:ARTHUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2792
Mailing Address - Country:US
Mailing Address - Phone:859-292-9176
Mailing Address - Fax:859-292-9177
Practice Address - Street 1:1955 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2792
Practice Address - Country:US
Practice Address - Phone:859-292-9176
Practice Address - Fax:859-292-9177
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA531363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK055151Medicare PIN