Basic Information
Provider Information
NPI: 1003142852
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ATKINS
FirstName: DAVID
MiddleName: CHARLES
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3085 LAKECREST CIR
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405131707
CountryCode: US
TelephoneNumber: 8592588600
FaxNumber: 8592588610
Practice Location
Address1: 3085 LAKECREST CIR
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405131707
CountryCode: US
TelephoneNumber: 8592588600
FaxNumber: 8592588610
Other Information
ProviderEnumerationDate: 10/29/2009
LastUpdateDate: 03/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XTC055KYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
TC05501KYKY PA LICENSEOTHER


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