KENNETH RICHARD PHELPS (NPI# 1669807210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669807210 |
| Entity Type | Individual |
| Full Name | KENNETH RICHARD PHELPS |
| Credential | PA-C |
| Practice Address |
3599 University Blvd S Bldg. 300 Jacksonville FL 32216-4252 |
| Practice Telephone | 9043995550 |
| Practice Fax Number | 9043464334 |
| Mailing Telephone | 9043995550 |
| Mailing Fax Number | 9043464334 |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2013-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9107403 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508882671 | Kenneth J Phelps Jr. | Family Medicine | 304 W Church St, Lewisburg, TN 37091 | 2006-07-14 |
| 1093135469 | Kenneth Scott Phelps | Acupuncturist | 13939 E 14th St Ste 150, San Leandro, CA 94578-2601 | 2014-04-23 |
| 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 |
3599 UNIVERSITY BLVD S BLDG. 300 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32216-4252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578568952 | Dawn Nichelle Rosado | Physical Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2005-06-14 |
| 1568061158 | Azucena Crosbie | Social Worker | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2020-10-23 |
| 1033735139 | Kristen Duncan | Physical Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2020-06-24 |
| 1336763184 | Amanda Ault | Occupational Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2020-06-07 |
| 1699309989 | Christina Brown | Nurse Practitioner | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2020-02-26 |
| 1396383949 | Abby Maillet | Physical Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2019-12-13 |
| 1760034383 | Lauren Campbell Vann | Physical Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2019-07-13 |
| 1740842178 | Charmaine Uy | Occupational Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2019-07-06 |
| 1871155317 | Michael Braun | Occupational Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2019-07-05 |
| 1023670775 | Alys Cook | Physical Therapist | 3599 University Blvd S, Jacksonville, FL 32216-4252 | 2019-07-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
| 1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
| 1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
| 1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
| 1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
| 1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
| 1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
| 1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
| Find all providers in zip 32216 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831799527 | Emily Vander Zee | Physician Assistant | 6680 Bennett Creek Dr Apt 213, Jacksonville, FL 32216-0018 | 2020-10-30 |
| 1245830314 | Jonathan V Korah | Physician Assistant | 6650 Corporate Center Pkwy Apt 1108, Jacksonville, FL 32216-8725 | 2020-10-28 |
| 1255931473 | Rachel Gavrielle Stahly | Physician Assistant | 11438 Emuness Rd, Jacksonville, FL 32218-4050 | 2020-10-27 |
| 1760099071 | Laura Alexandra Ramos-heckman | Physician Assistant | 2014 Capistrano Dr, Jacksonville, FL 32224-3091 | 2020-09-30 |
| 1184230583 | Julian Clouse | Physician Assistant | 9803 Creekfront Rd Apt 307, Jacksonville, FL 32256-8449 | 2020-09-21 |
| 1962016717 | Stephanie Benton Gentry | Physician Assistant | 3179 Shadow Creek Rd, Jacksonville, FL 32226-2386 | 2020-08-31 |
| 1629689435 | Monarch Mental Health Association | Physician Assistant | 5393 Roosevelt Blvd Ste 8, Jacksonville, FL 32210-8424 | 2020-08-14 |
| 1235749425 | Nicole Lhommedieu | Physician Assistant | 3850 Marnie Pl, Jacksonville, FL 32223-3541 | 2020-08-03 |
| 1861002123 | Naw-am Acio Daniels | Physician Assistant | 7467 Volley Dr N, Jacksonville, FL 32277-9368 | 2020-08-03 |
| 1750906640 | Veronica Adriana Dediego | Physician Assistant | 915 W Monroe St Ste 300, Jacksonville, FL 32204-1177 | 2020-06-16 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32216 |
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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.