Provider Demographics
NPI:1831878339
Name:MCCLANAHAN, LEXI LILLIAN (PA-C)
Entity type:Individual
Prefix:
First Name:LEXI
Middle Name:LILLIAN
Last Name:MCCLANAHAN
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 1:1509 BARDSTOWN RD APT C
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1191
Mailing Address - Country:US
Mailing Address - Phone:740-507-8684
Mailing Address - Fax:
Practice Address - Street 1:6001 CLAYMONT VILLAGE DR STE 2
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-6554
Practice Address - Country:US
Practice Address - Phone:502-805-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
KYTC036363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant