Provider Demographics
NPI:1063746691
Name:HANNA, LYNN C (PA-C)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:HANNA
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 1:465 E HIGH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1938
Mailing Address - Country:US
Mailing Address - Phone:859-258-2733
Mailing Address - Fax:859-258-2733
Practice Address - Street 1:465 E HIGH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1938
Practice Address - Country:US
Practice Address - Phone:859-258-2733
Practice Address - Fax:859-258-2733
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA074363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical