Individual
GENNA COLLEEN PETREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7001
(859) 323-1100
Mailing address
800 ROSE ST, LEXINGTON, KY 40536-7001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC275
KY
363AM0700X
Medical Physician Assistant
TC275
KY
363AS0400X
Surgical Physician Assistant
TC275
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/25/2022
Last updated
09/08/2022
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