Provider Demographics
NPI:1205162252
Name:KENNEDY, LUCAS J (PA)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:J
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:UK DIVISION OF DIGESTIVE DISEASES
Mailing Address - Street 2:800 ROSE STREET, MN649
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-4887
Mailing Address - Fax:
Practice Address - Street 1:UK DIVISION OF DIGESTIVE DISEASES
Practice Address - Street 2:740 S. LIMESTONE, 2ND FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-0079
Practice Address - Fax:859-257-9287
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2020-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA1219363AM0700X, 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
KY7100104090Medicaid
KY0527434Medicare PIN
KY7100104090Medicaid