Provider Demographics
NPI:1801926845
Name:CONN, FARRAH J (PA-C)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:J
Last Name:CONN
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 1:113 AUTUMN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1646
Mailing Address - Country:US
Mailing Address - Phone:859-585-5022
Mailing Address - Fax:
Practice Address - Street 1:113 AUTUMN RIDGE DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1646
Practice Address - Country:US
Practice Address - Phone:859-585-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA663363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500311700Medicaid
KY0693523OtherMEDICARE