Individual
BRENT ANDREW IVY COTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
740 S LIMESTONE, LEXINGTON, KY 40536-0001
(859) 323-5544
(859) 257-9288
Mailing address
740 S LIMESTONE, LEXINGTON, KY 40536-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2842
KY
363A00000X
Physician Assistant
TC075
KY
363AM0700X
Medical Physician Assistant
PA2842
KY
363AM0700X
Medical Physician Assistant
TC075
KY
363AS0400X
Surgical Physician Assistant
PA2842
KY
363AS0400X
Surgical Physician Assistant
TC075
KY
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/11/2021
Last updated
01/04/2022
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