Provider Demographics
NPI:1205937323
Name:FARRIS, JAMES K (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:FARRIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SHOPPERS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1301
Mailing Address - Country:US
Mailing Address - Phone:859-737-5333
Mailing Address - Fax:859-737-0070
Practice Address - Street 1:404 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1301
Practice Address - Country:US
Practice Address - Phone:859-737-5333
Practice Address - Fax:859-737-0070
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100403180Medicaid