DR. KEVIN PETTUS (NPI# 1679641609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679641609 |
| Entity Type | Individual |
| Full Name | DR. KEVIN PETTUS |
| Credential | MD |
| Practice Address |
7786 Lexington Rd Lancaster KY 40444-9119 |
| Mailing Address |
Po Box 2185 Danville KY 40423-2185 |
| Practice Telephone | 8595484114 |
| Practice Fax Number | 8595482718 |
| Mailing Telephone | 8595484114 |
| Mailing Fax Number | 8595482718 |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2009-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 173000000X | Legal Medicine | 41148 | KY | Other Service Providers |
| Y | 207Q00000X | Family Medicine | 41148 | KY | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 01056257A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | BCBS-BGC STANFORD PLLC | 000000536447 | 01 |
| KY | BCBS-STANFORD FAMILY MED | 000000536456 | 01 |
| KY | BCBS-BGC LIBERTY, PLLC | 000000536458 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265848717 | Kevin Lee Pettus | Counselor | 605 11th Ave E, Gooding, ID 83330-5368 | 2014-07-05 |
| Street Address |
7786 LEXINGTON RD |
| City | LANCASTER |
| State | KY |
| Zip Code | 40444-9119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467690198 | 4seeds Medical Clinic, Pllc | Clinic/Center | 7786 Lexington Rd, Lancaster, KY 40444-9119 | 2009-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851951362 | Christian Matthew Wyler | Optometrist | 304 Stanford St, Lancaster, KY 40444 | 2019-06-17 |
| 1366932766 | Tricia Harvey Jackson | Nurse Practitioner | 230 Lexington Rd, Suite D, Lancaster, KY 40444 | 2018-05-11 |
| 1982113148 | A1 Health Care Clinic | Family Medicine | 703 East Main Street, # 8, Lebanon, KY 40444 | 2017-09-20 |
| 1528517034 | Med-save 4 LLC | Pharmacy | 208 Stanford St, Lancaster, KY 40444 | 2016-09-26 |
| 1013160993 | Robert H Hollingsworth | Dentist | 1183 Stanford Road, Lancaster, KY 40444 | 2008-10-23 |
| 1447474168 | Felix Joseph Johnson | Dentist | 1183 Stanford Rd, Lancaster, KY 40444 | 2007-04-12 |
| 1417002114 | Ephraim Mcdowell Health Resource, Inc. | Family Medicine | 501 N Camp Dick Rd, Lancaster, KY 40444 | 2007-01-24 |
| 1336166198 | Modern Therapy & Gas LLC | Durable Medical Equipment & Medical Supplies | 401 Danville St, Lancaster, KY 40444 | 2006-07-17 |
| 1023092251 | Lancaster Medical Investors LLC | Nursing Facility/Intermediate Care Facility | 308 West Maple Ave, Lancaster, KY 40444 | 2005-12-01 |
| 1114071545 | David Lee Vanzant Jr. | Dentist | 309 Lexington Road, Lancaster, KY 40444-0770 | 2007-01-23 |
| Find all providers in zip 40444 | ||||
| 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 |
|---|---|---|---|---|
| 1619580693 | Erica Jayne Mack | Family Medicine | 542 W Mulberry St, Lancaster, OH 43130-2907 | 2020-08-28 |
| 1134732753 | Ovp Health Care, Inc. | Family Medicine | 101 S Catawba St, Lancaster, SC 29720-2411 | 2020-08-24 |
| 1477174027 | Omnis Medical Group | Family Medicine | 401 North Ewing Street, Lancaster, OH 43130 | 2020-05-05 |
| 1134765456 | Lancaster General Medical Group | Family Medicine | 100 N Queen St Ste 200, Lancaster, PA 17603-3550 | 2019-11-21 |
| 1578116927 | Pamela Joann Jacobs | Family Medicine | 77 Westwood Rd, Lancaster, NY 14086-9522 | 2019-07-23 |
| 1730642786 | Covenantmd, LLC | Family Medicine | 930 Red Rose Ct Ste 104, Lancaster, PA 17601-1981 | 2019-04-08 |
| 1720542244 | Bryan C Benefiel, M.d. Inc. | Family Medicine | 44725 10th St W Ste 290, Lancaster, CA 93534-3049 | 2019-01-29 |
| 1154898179 | Crystal B Clark | Family Medicine | 112 Woodland Drive, Lancaster, SC 29720 | 2018-10-29 |
| 1689167751 | Jacqueline Palmer | Family Medicine | 45465 25th St E Spc 168, Lancaster, CA 93535-2392 | 2018-06-12 |
| 1154851384 | Pinnacle Health Regional Physicians | Family Medicine | 250 College Ave Ste 300, Lancaster, PA 17603-3363 | 2017-06-20 |
| Find all providers in LANCASTER | ||||
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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.