Provider Demographics
NPI:1942827183
Name:FARRAN, MICHAEL DALE ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DALE ANTHONY
Last Name:FARRAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:DALE ANTHONY
Other - Last Name:FARRAN-BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1401 HARRODSBURG RD STE C405
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1748
Practice Address - Country:US
Practice Address - Phone:859-276-4429
Practice Address - Fax:859-313-1095
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant