Provider Demographics
NPI:1780600932
Name:BUFORD, LISA J (PA-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:J
Last Name:BUFORD
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636961
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6961
Mailing Address - Country:US
Mailing Address - Phone:513-981-5130
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:1532 LONE OAK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7913
Practice Address - Country:US
Practice Address - Phone:270-538-6700
Practice Address - Fax:270-538-6755
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005518Medicaid
S96410Medicare UPIN
KY95005518Medicaid