Provider Demographics
NPI:1457364515
Name:WOOLLEY, CLAUDIA (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:WOOLLEY
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 1:2420 ARGILLITE RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-1972
Mailing Address - Country:US
Mailing Address - Phone:606-836-3900
Mailing Address - Fax:606-836-0205
Practice Address - Street 1:2420 ARGILLITE RD STE B
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1972
Practice Address - Country:US
Practice Address - Phone:606-836-3900
Practice Address - Fax:606-836-0205
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95003174Medicaid
KYP07333Medicare UPIN
KY95003174Medicaid