Individual
VICTORIA A YATSUKNENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2307 RIVER RD STE 101, LOUISVILLE, KY 40206-5000
(502) 583-6647
(502) 585-4824
Mailing address
2307 RIVER RD STE 101, LOUISVILLE, KY 40206-5000
(502) 583-6647
(502) 585-4824
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1148
KY
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000588926
ANTHEM BLUE CROSS AND BLUE SHIELD
KY
01
—
C60483
CUMBERLAND HEALTHCARE
—
Enumeration date
10/01/2008
Last updated
04/12/2021
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