Basic Information
| Provider Information | |||||||||
| NPI: | 1134224355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SVETICH | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 DOVE RUN RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405023536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592680061 | ||||||||
| FaxNumber: | 8592661152 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 DOVE RUN RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405023536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592680061 | ||||||||
| FaxNumber: | 8592661152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 12/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA119 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | PA119 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 95001194 | 05 | KY | MEDICAID | CB5773 | 01 | KY | RR MEDICARE GROUP | OTHER | 4000501 | 01 | KY | MEDICARE LAB GROUP | OTHER | 37903705 | 01 | KY | MEDICAID LAB GROUP | OTHER | P00036568 | 01 | KY | RR MEDICARE PIN | OTHER |