Individual
MICAH LYNETTE SANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1401 HARRODSBURG RD STE B275, LEXINGTON, KY 40504-1775
(859) 278-2334
(859) 278-0159
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1226
KY
363AM0700X
Medical Physician Assistant
PA1226
KY
363AS0400X
Surgical Physician Assistant
PA1226
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100104130
—
KY
01
—
PA1226
KY LICENSE
KY
Enumeration date
08/28/2009
Last updated
09/13/2021
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