Individual
MANPREET K. DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-4608
(859) 257-1000
Mailing address
740 S LIMESTONE L543, LEXINGTON, KY 40536-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2262
KY
363A00000X
Physician Assistant
TC665
KY
363AM0700X
Medical Physician Assistant
PA2262
KY
363AS0400X
Surgical Physician Assistant
PA2262
KY
Other
Enumeration date
05/01/2012
Last updated
08/17/2020
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