Provider Demographics
NPI:1457342438
Name:PICARD, ROBERT T (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:PICARD
Suffix:
Gender:M
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 1:104 HARDIN LN
Mailing Address - Street 2:STE # A
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3800
Mailing Address - Country:US
Mailing Address - Phone:606-678-8323
Mailing Address - Fax:606-451-0133
Practice Address - Street 1:104 HARDIN LN
Practice Address - Street 2:STE # A
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3800
Practice Address - Country:US
Practice Address - Phone:606-678-8323
Practice Address - Fax:606-451-0133
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA036363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY970012785OtherMC RAILROAD #
KY000000203696OtherBCBS PHYS.ASSISTANT #
KY9500002200Medicaid
KY000000203696OtherBCBS PHYS.ASSISTANT #
KYS96223Medicare UPIN