Basic Information
| Provider Information | |||||||||
| NPI: | 1194731919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAXSON | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 PASADENA DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405032973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592780319 | ||||||||
| FaxNumber: | 8592779699 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592689866 | ||||||||
| FaxNumber: | 8592680458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 10/30/2014 | ||||||||
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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 | 363LC0200X | 1036392 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | 363LF0000X | 3004097 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0000000309461 | 01 | KY | ANTHEM | OTHER | 78010592 | 05 | KY | MEDICAID |