MR. KENNETH J PHELPS JR. (NPI# 1508882671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508882671 |
| Entity Type | Individual |
| Full Name | MR. KENNETH J PHELPS JR. |
| Credential | MD |
| Practice Address |
304 W Church St Lewisburg TN 37091 |
| Practice Telephone | 9313593551 |
| Practice Fax Number | 9313598421 |
| Mailing Telephone | 9313593551 |
| Mailing Fax Number | 9313598421 |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-10-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD007988 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BLUE CROSS BLUE SHIELD | 2002276 | 01 | |
| TN | PTAN GROUP | 3719237 | 01 |
| TN | PTAN INDIVIDUAL | 3162791 | 01 |
| TN | 3162794 | 05 | |
| TN | 3719237 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093135469 | Kenneth Scott Phelps | Acupuncturist | 13939 E 14th St Ste 150, San Leandro, CA 94578-2601 | 2014-04-23 |
| 1669807210 | Kenneth Richard Phelps | Physician Assistant | 3599 University Blvd S, Bldg. 300, Jacksonville, FL 32216-4252 | 2013-09-13 |
| 1942439302 | Kenneth W Phelps | Marriage & Family Therapist | 3555 Harden Street Ext, 15 Medical Park, Suite 141, Columbia, SC 29203-6894 | 2009-07-07 |
| 1831184670 | Kenneth Raymond Phelps | Internal Medicine | 47 New Scotland Ave, Albany, NY 12208-3412 | 2005-09-19 |
| Street Address |
304 W CHURCH ST |
| City | LEWISBURG |
| State | TN |
| Zip Code | 37091 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972037372 | Carenation, LLC | Durable Medical Equipment & Medical Supplies | 304 W Church St, Lewisburg, TN 37091-2730 | 2017-04-12 |
| 1679007017 | America Cares Trust, Inc (act) | Clinic/Center | 304 W Church St, Lewisburg, TN 37091-2730 | 2017-04-12 |
| 1386035210 | Holly Nachole Garland | Nurse Practitioner | 304 W Church St, Lewisburg, TN 37091 | 2015-02-13 |
| 1255525630 | Cynthia Elaine Kelley | Nurse Practitioner | 304 W Church St, Lewisburg, TN 37091-2730 | 2007-08-29 |
| 1275759011 | Kenneth J Phelps Md | Specialist | 304 W Church St, Lewisburg, TN 37091-2730 | 2007-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275168817 | South Medical Clinic LLC | Family Medicine | 118 2nd Ave South, Lewisburg, TN 37091 | 2020-03-04 |
| 1063968345 | Joe Swinney IIi | Case Management | 3756 Tom Littlejohn Rd, Lewisburg, TN 37091 | 2016-08-28 |
| 1396142485 | The Estate of P. Laray Rector | Dentist | 553 W Commerce St, Lewisburg, TN 37091 | 2014-12-04 |
| 1093958092 | Tamara Carolynn Holley | Case Manager/Care Coordinator | 1603 Nashville Highway, Lewisburg, TN 37091 | 2009-04-07 |
| 1285897793 | Jennifer Val Neel | Nurse Practitioner | 329 West Commerce Street, Lewisburg, TN 37091 | 2008-07-03 |
| 1316138639 | Bio-medical Applications of Tennessee, Inc. | Clinic/Center | 1030 War Eagle Drive, Lewisburg, TN 37091 | 2007-08-05 |
| 1568561850 | John Woodson Carter | Dentist | 1085 N Ellington Pkwy, Lewisburg, TN 37091 | 2006-09-22 |
| 1760448500 | Edward D White Jr. | Nurse Practitioner | 710 Cornersville Rd, Lewisburg, TN 37091 | 2006-04-21 |
| 1548243348 | Air Evac Ems Inc | Ambulance | 1879 Franklin Pike, Lewisburg, TN 37091 | 2005-11-25 |
| 1013216498 | Montclair Health and Wellness LLC | Nurse Practitioner | 710 Cornersville Rd, Lewisburg, TN 37091 | 2011-03-24 |
| Find all providers in zip 37091 | ||||
| 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 |
|---|---|---|---|---|
| 1275168817 | South Medical Clinic LLC | Family Medicine | 118 2nd Ave South, Lewisburg, TN 37091 | 2020-03-04 |
| 1437780269 | Healthcare 360 Pllc | Family Medicine | 208 Dawkins Drive, Lewisburg, WV 24901 | 2020-01-30 |
| 1679728471 | Nathaniel Harris | Family Medicine | Chestnut Flats Rd, Box 1042, Lewisburg, WV 24901-4042 | 2008-11-20 |
| 1023294600 | Colleen Ann Flaherty | Family Medicine | 4 Snake Road, Bucknell University Ziegler Student Health Center, Lewisburg, PA 17837 | 2008-01-14 |
| 1497944607 | Charles S. Mcclung Sr., Do | Family Medicine | 226 Skylar Dr, Lewisburg, WV 24901-9383 | 2007-10-24 |
| 1154416725 | Kendall L Wilson Jr. | Family Medicine | 409 North Lee Street, Lewisburg, WV 24901-0626 | 2006-10-03 |
| 1942210513 | Jeanne Marie Wahl | Family Medicine | 400 North Jefferson Street, Lewisburg, WV 24901 | 2006-08-08 |
| 1447279807 | John Lawrence Ginsburg | Family Medicine | 55 N 5th St, Lewisburg, PA 17837-1407 | 2006-07-18 |
| 1780609701 | Suzanne Greb | Family Medicine | 7095 Westbranch Highway, Suite 1100, Lewisburg, PA 17837-6808 | 2006-07-12 |
| 1518907294 | Christopher D Olson | Family Medicine | 506 Country Rd, Lewisburg, PA 17837-7065 | 2006-06-08 |
| Find all providers in LEWISBURG | ||||
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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.