Provider Demographics
NPI:1356394787
Name:NOBLE, KATHERINE B (PA-C)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:B
Last Name:NOBLE
Suffix:
Gender:F
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:175 CITY HILL DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3038
Practice Address - Country:US
Practice Address - Phone:606-877-2050
Practice Address - Fax:606-877-2080
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000479686OtherBCBS OF KY
KY95004305Medicaid
KY00005002Medicare PIN
P65113Medicare UPIN
KYP00395921Medicare PIN