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Organization

PATRIOT ONE PRIMARY CARE PSC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ELIZABETH MENTZER PA-C (OWNER)
(859) 447-8014
Entity
Organization

Contact information

Practice address
989 GOVERNORS LN STE 220, LEXINGTON, KY 40513-1175
(859) 447-8014
(859) 447-8013
Mailing address
989 GOVERNORS LN STE 220, LEXINGTON, KY 40513-1175
(859) 447-8014

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
363LP0200X
Pediatric Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100137000
KY
Enumeration date
05/04/2022
Last updated
08/02/2022
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