Provider Demographics
NPI:1457720724
Name:DEBACHER, MARY KATELYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATELYNN
Last Name:DEBACHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATELYNN
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 S BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4568
Mailing Address - Fax:859-258-4698
Practice Address - Street 1:1225 S BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-258-4568
Practice Address - Fax:859-258-4698
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002217A363A00000X
KYPA2024363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant