Provider Demographics
NPI:1851423040
Name:LYKINS, WESLEY MARK (PA-C)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:MARK
Last Name:LYKINS
Suffix:
Gender:
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:859-497-4137
Practice Address - Street 1:211 FOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2694
Practice Address - Country:US
Practice Address - Phone:859-264-9820
Practice Address - Fax:859-585-5797
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300017459Medicaid
KY7100027610Medicaid