Provider Demographics
NPI:1457421513
Name:HOOGERHEIDE, PAIGE LYNNE (PA-C, SA-C)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:LYNNE
Last Name:HOOGERHEIDE
Suffix:
Gender:F
Credentials:PA-C, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DESHA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1802
Mailing Address - Country:US
Mailing Address - Phone:859-269-8376
Mailing Address - Fax:859-269-8376
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:859-396-8647
Practice Address - Fax:859-269-8376
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA137363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS47663Medicare UPIN