Individual
MR. DREW PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
1207 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-8575
(859) 258-8562
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT1319
KY
363A00000X
Physician Assistant
AT1319
—
363A00000X
Physician Assistant
Primary
PA2746
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100778720
—
KY
Enumeration date
12/22/2015
Last updated
04/08/2025
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