Provider Demographics
NPI:1790741163
Name:KOUNS, PAMELA R (PA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:KOUNS
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 1:2333 ALUMNI PARK PLAZA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4022
Mailing Address - Country:US
Mailing Address - Phone:859-218-5677
Mailing Address - Fax:859-257-7899
Practice Address - Street 1:740 SOUTH LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-8082
Practice Address - Fax:859-257-5901
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA876363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95004974Medicaid
0621243Medicare ID - Type Unspecified
KY95004974Medicaid
KY0621243Medicare PIN