Provider Demographics
NPI:1356414494
Name:SNELLING, LAUREL J (PA, CSA)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:J
Last Name:SNELLING
Suffix:
Gender:F
Credentials:PA, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 DESHA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1801
Mailing Address - Country:US
Mailing Address - Phone:859-268-8415
Mailing Address - Fax:859-268-8415
Practice Address - Street 1:838 E HIGH ST
Practice Address - Street 2:#288
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2107
Practice Address - Country:US
Practice Address - Phone:859-396-3647
Practice Address - Fax:859-268-8415
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA313363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS96484Medicare UPIN