JORDAN MYERS PRENDERGAST (NPI# 1396905998) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396905998 |
| Entity Type | Individual |
| Full Name | JORDAN MYERS PRENDERGAST |
| Credential | DO |
| Practice Address |
630 Southpoint Dr Lexington KY 40515-6350 |
| Practice Telephone | 8592721928 |
| Practice Fax Number | 8592719601 |
| Mailing Telephone | 8592721928 |
| Mailing Fax Number | 8592719601 |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2016-11-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 03156 | KY | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | R1335 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | KENTUCKY STATE LICENSE | R1335 | 01 |
| KY | KY LICENSE | 03156 | 01 |
| Street Address |
630 SOUTHPOINT DR |
| City | LEXINGTON |
| State | KY |
| Zip Code | 40515-6350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922024124 | Craig W. Irwin | Internal Medicine | 630 Southpoint Dr, Lexington, KY 40515-6350 | 2006-07-14 |
| 1154659043 | Hannah S. Atkins | Physician Assistant | 630 Southpoint Dr, Lexington, KY 40515-6350 | 2009-12-03 |
| 1669634440 | Marisa Pauline Belcastro | Family Medicine | 630 Southpoint Dr, Lexington Clinic Veterans Park, Lexington, KY 40515-6350 | 2008-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730699620 | Cassandra Grace Reynolds | Occupational Therapy Assistant | 3900 Crosby Dr Apt 102, Lexington, KY 40515 | 2017-10-04 |
| 1447793401 | Audrey Mccall Logan | Counselor | 3479 Buckhorn Drive, Ste 106, Lexington, KY 40515 | 2016-11-23 |
| 1043760465 | Mary Lauren Elizabeth Willis | Pharmacist | 4251 Mooncoin Way, Lexington, KY 40515 | 2016-10-10 |
| 1417334103 | William Douglas Hacker | Pediatrics | 4856 Pleasant Grove Road, Lexington, KY 40515 | 2015-05-01 |
| 1528480340 | Frances Ann Cook | Psychologist | 4105 Heartwood Rd, Lexington, KY 40515 | 2014-01-14 |
| 1245574532 | Patricia H Woodruff | Nurse Practitioner | 3030 Brookmonte Ln, Lexington, KY 40515 | 2012-11-27 |
| 1225381064 | Tiffany Kruger | Physical Therapist | 1092 Duval St Ste 210, Lexington, KY 40515 | 2012-10-17 |
| 1356698203 | Jessika Cordell Vance-morgan | Behavioral Analyst | 945 Darda Ct, Lexington, KY 40515 | 2012-08-09 |
| 1285915363 | Southern Office Solutions | Specialist | 5060 Ivybridge Dr., Lexington, KY 40515 | 2011-09-02 |
| 1578794426 | Emilie Carter | Social Worker | 1096 Duval St Ste 140, Lexington, KY 40515 | 2009-07-27 |
| Find all providers in zip 40515 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890431 | Alishia Gayle Euler | Family Medicine | 730 Della Dr, Lexington, KY 40504-3610 | 2020-11-01 |
| 1053919514 | Kelli Lichte | Family Medicine | 601 S 13 Hwy, Lexington, MO 64067-1511 | 2020-10-15 |
| 1851906267 | Avneet Nagra | Family Medicine | 162 Montauk Dr, Lexington, SC 29072-6776 | 2020-09-11 |
| 1922624774 | Cindy Viers | Family Medicine | 310 Oxford Rd, Lexington, OH 44904-1039 | 2020-06-17 |
| 1992338818 | Sarah Angelina Clem | Family Medicine | 2251 War Admiral Way Ste 125, Lexington, KY 40509-2546 | 2020-02-19 |
| 1073144481 | Bluegrass Primary Health Care Center, Inc. | Family Medicine | 224 N Martin Luther King Blvd Ste 200, Lexington, KY 40507-2133 | 2020-02-04 |
| 1952955056 | Preferred Injury Physicians LLC | Family Medicine | 2700 Old Rosebud Rd Ste 330, Lexington, KY 40509-8630 | 2019-07-26 |
| 1144888579 | Lexington Regional Health Center | Family Medicine | 1101 Buffalo Bnd Ste A, Lexington, NE 68850-1528 | 2019-05-31 |
| 1881258085 | Mallory Jade Guagenti | Family Medicine | 3399 Tates Creek Rd Ste 230, Lexington, KY 40502-7404 | 2019-04-24 |
| 1699230540 | Novant Medical Group. Inc. | Family Medicine | 4705 S Highway 150, Lexington, NC 27295-5203 | 2019-02-05 |
| Find all providers in LEXINGTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.