Individual
MYRA M. DELUCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1019 MAJESTIC DR STE 210, LEXINGTON, KY 40513-1947
(859) 277-3114
(859) 275-1942
Mailing address
1019 MAJESTIC DR STE 210, LEXINGTON, KY 40513-1947
(859) 277-3114
(859) 276-2392
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA348
KY
363AM0700X
Medical Physician Assistant
PA348
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4000501
MEDICARE LAB GRP
KY
01
—
CB5773
RR MEDICARE GRP
GA
01
—
P00356806
RR MEDICARE PIN
GA
Enumeration date
10/02/2006
Last updated
11/13/2024
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