Provider Demographics
NPI:1336166909
Name:CALDWELL-ONEY, BRANDY LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LYNN
Last Name:CALDWELL-ONEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:BRANDY
Other - Middle Name:LYNN
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 TRADE STREET
Mailing Address - Street 2:STE 155
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511
Mailing Address - Country:US
Mailing Address - Phone:859-425-2555
Mailing Address - Fax:859-367-4957
Practice Address - Street 1:2195 HARRODSBURG RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3543
Practice Address - Country:US
Practice Address - Phone:859-323-6371
Practice Address - Fax:859-257-3585
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC640363A00000X
KYPA906363AM0700X, 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
INPA401Medicare UPIN
KY0990002Medicare ID - Type Unspecified