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Individual

COURTNEY TADIC

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1138 LEXINGTON RD STE 290, GEORGETOWN, KY 40324-9672
(502) 863-0721
(502) 863-6104
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2787
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100733660
KY
Enumeration date
04/07/2021
Last updated
06/10/2024
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