Provider Demographics
NPI:1053789750
Name:KNEZEVIC, VEDRANA (PA-C)
Entity type:Individual
Prefix:
First Name:VEDRANA
Middle Name:
Last Name:KNEZEVIC
Suffix:
Gender:
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 1:3000 BAPTIST HEALTH BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8742
Mailing Address - Country:US
Mailing Address - Phone:859-639-0920
Mailing Address - Fax:859-639-0921
Practice Address - Street 1:3000 BAPTIST HEALTH BLVD STE 340
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8742
Practice Address - Country:US
Practice Address - Phone:859-639-0920
Practice Address - Fax:859-639-0921
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK188620Medicare PIN