Provider Demographics
NPI:1790736817
Name:HOWARD, HOLLY M (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:M
Last Name:HOWARD
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 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE C100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-4960
Mailing Address - Fax:859-278-0033
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE C100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-4960
Practice Address - Fax:859-278-0033
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA717363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100033440Medicaid
KYP00472281OtherRAILROAD MEDICARE
KY7100033440Medicaid
KY0542715Medicare PIN
KY1267235Medicare ID - Type Unspecified