Provider Demographics
NPI:1194731919
Name:PAXSON, RITA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:PAXSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2973
Mailing Address - Country:US
Mailing Address - Phone:859-278-0319
Mailing Address - Fax:859-277-9699
Practice Address - Street 1:3101 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1599
Practice Address - Country:US
Practice Address - Phone:859-268-9866
Practice Address - Fax:859-268-0458
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1036392363LC0200X
KY3004097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000309461OtherANTHEM
KY78010592Medicaid
KY0000000309461OtherANTHEM
KY78010592Medicaid