Provider Demographics
NPI:1902200413
Name:BUCKEL, MICAH (PA-C)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:BUCKEL
Suffix:
Gender:M
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 1:2101 NICHOLASVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2517
Practice Address - Country:US
Practice Address - Phone:859-278-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC334363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical