Individual provider Active NPI

Teshla Rae Ratcliff, PA

  • Physician Assistant
  • Louisville, KY
National Provider Identifier
1629313010
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1790 Issued in KY
Practice address
3999 Dutchmans LN Ste 4a
Louisville, KY 40207-4745
Phone
(502) 365-2655
NPI assigned
Dec 11, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1790 KY Primary

Addresses

Primary practice location

3999 Dutchmans LN Ste 4a
Louisville, KY 40207-4745

Mailing address

3999 Dutchmans LN Ste 4a
Louisville, KY 40207-4745
Phone (502) 365-2655

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130205000271 KY Practitioner - Physician Assistant 0143474833 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1790KYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New Lexington Clinic, PSC CurrentSince Oct 31, 2023 Accepting new patients
New Lexington Clinic PSC CurrentSince Oct 31, 2023 Accepting new patients
Richmond Nephrology & Hypertension PSC Past Accepting new patients

Locations

1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000

1221 S Broadway
Lexington, KY 40504
Phone (859) 258-4181

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1629313010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3999 DUTCHMANS LN STE 4A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074745",
            "telephone_number": "502-365-2655",
            "fax_number": "502-365-2770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 DUTCHMANS LN STE 4A",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074745",
            "telephone_number": "502-365-2655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RATCLIFF",
        "first_name": "TESHLA",
        "middle_name": "RAE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-11",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA1790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.