Individual
MRS. JACLYN MILLER CONDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
UK UROLOGY CLINIC, 740 S LIMESTONE STE B200, LEXINGTON, KY 40536
(859) 257-3533
Mailing address
3099 HELMSDALE PL, LEXINGTON, KY 40509-2213
(859) 258-6401
(859) 258-6438
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2320
KY
363A00000X
Physician Assistant
—
KY
363AM0700X
Medical Physician Assistant
PA2320
KY
363AS0400X
Surgical Physician Assistant
PA2320
KY
Other
Enumeration date
06/17/2016
Last updated
09/29/2020
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