Provider Demographics
NPI:1952674574
Name:LEXINGTON PRIMARY CARE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LEXINGTON PRIMARY CARE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GITANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:859-543-0005
Mailing Address - Street 1:151 N EAGLE CREEK DR
Mailing Address - Street 2:STE 320
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1889
Mailing Address - Country:US
Mailing Address - Phone:859-543-0005
Mailing Address - Fax:859-543-0474
Practice Address - Street 1:151 N EAGLE CREEK DR
Practice Address - Street 2:STE 320
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1889
Practice Address - Country:US
Practice Address - Phone:859-543-0005
Practice Address - Fax:859-543-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100205680Medicaid
KYK038390Medicare PIN