Provider Demographics
NPI:1053789750
Name:KNEZEVIC, VEDRANA (PA-C)
Entity type:Individual
Prefix:
First Name:VEDRANA
Middle Name:
Last Name:KNEZEVIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 LEXINGTON GREEN CIR
Mailing Address - Street 2:STE 600
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:161 N EAGLE CREEK DR
Practice Address - Street 2:STE 400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9038
Practice Address - Country:US
Practice Address - Phone:859-226-0031
Practice Address - Fax:859-226-0041
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2020-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA2035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK188620Medicare PIN