Individual
SRILATHA RAGHUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2616 LEGENDS WAY, CRESTVIEW HILLS, KY 41017-2418
(859) 331-3100
(859) 331-9147
Mailing address
2616 LEGENDS WAY, CRESTVIEW HILLS, KY 41017-2418
(859) 331-3100
(859) 331-9147
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10003177A
IN
363A00000X
Physician Assistant
3908
TN
363A00000X
Physician Assistant
Primary
PA2423
KY
363A00000X
Physician Assistant
TC763
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05033505
—
MS
01
—
6197540
BCBS
TN
Enumeration date
10/10/2018
Last updated
06/30/2021
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