Provider Demographics
NPI:1154356376
Name:BURNS, MARTHA L (PA-C)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:L
Last Name:BURNS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2109 DRESDEN CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-2418
Mailing Address - Country:US
Mailing Address - Phone:859-523-8091
Mailing Address - Fax:859-257-7715
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:ROOM CC407 ROACH BUILDING
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-257-6940
Practice Address - Fax:859-257-7715
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA-207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical