FACIAL PLASTIC SURGERY & DERMATOLOGY PLLC (NPI# 1881030088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881030088 |
| Entity Type | Organization |
| Organization Name | FACIAL PLASTIC SURGERY & DERMATOLOGY PLLC |
| Practice Address |
448 Lewis Hargett Cir Ste 240 Lexington KY 40503-3594 |
| Mailing Address |
3070 Lakecrest Cir Ste. 400-264 Lexington KY 40513-1937 |
| Practice Telephone | 8592260206 |
| Practice Fax Number | 8592260207 |
| Mailing Telephone | 8592260206 |
| Mailing Fax Number | 8592260207 |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2013-08-27 |
| Authorized Official Name | SAMUEL JACK PRUDEN II (OWNER) |
| Authorized Official Telephone | 8592260206 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 34192 | KY | Allopathic & Osteopathic Physicians |
| N | 208200000X | Plastic Surgery | 34192 | KY | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
34192 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100245900 | 05 | |
| KY | ANTHEM BCBS | 000000823139 | 01 |
| Street Address |
448 LEWIS HARGETT CIR STE 240 |
| City | LEXINGTON |
| State | KY |
| Zip Code | 40503-3594 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740586932 | John Casey Clark | Occupational Therapist | 448 Lewis Hargett Cir, Suite 100, Lexington, KY 40503-3594 | 2011-02-04 |
| 1285233031 | Lex Kidney Care Pllc | Internal Medicine | 448 Lewis Hargett Cir, Lexington, KY 40503-3594 | 2020-10-22 |
| 1174066849 | Center for Comprehensive Services, Inc | Rehabilitation Hospital | 448 Lewis Hargett Cir, Ste 100, Lexington, KY 40503-3594 | 2016-11-29 |
| 1841658127 | Kelly J Williams | Occupational Therapist | 448 Lewis Hargett Cir, Suite 100, Lexington, KY 40503-3594 | 2016-02-02 |
| 1053778308 | Shelley Helena Jackson | Speech-Language Pathologist | 448 Lewis Hargett Cir, Lexington, KY 40503-3594 | 2016-01-18 |
| 1073979928 | Leslie Atwood | Speech-Language Pathologist | 448 Lewis Hargett Cir, Suite 100, Lexington, KY 40503-3594 | 2016-01-07 |
| 1932579323 | Center for Comprehensive Services, Inc | Rehabilitation Hospital | 448 Lewis Hargett Cir, Ste 100, Lexington, KY 40503-3594 | 2015-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548804743 | Lucas Kyle Brothers | Occupational Therapist | 401 Lewis Hargett Cir #120, Lexington, KY 40503 | 2019-10-30 |
| 1598322364 | Bobbi Jo Macqueston | Developmental Therapist | 825 Apache Trail, Lexington, KY 40503 | 2019-05-28 |
| 1750846234 | Smart Dental & Hygiene Express | Dentist | 2600 Nicholasville Rd Suite 120, Lexington, KY 40503 | 2019-02-08 |
| 1780148353 | Southland Child, Adult, and Family Counseling | Counselor | 2039 Regency Rd., Ste 1, Lexington, KY 40503 | 2019-01-28 |
| 1073093357 | Amanda Zachem | Nurse Practitioner | 1780 Nicholasville Rd., Suite #203, Lexington, KY 40503 | 2018-08-16 |
| 1083101240 | Man O War Urgent Care LLC | Nurse Practitioner | 4097 Nichols Park Dr Ste 108, Lexington, KY 40503 | 2018-04-13 |
| 1255833737 | Bennett Gatto | Physical Therapist | 3882 Mall Road, Lexington, KY 40503 | 2018-03-01 |
| 1528566114 | Alteri, LLC | Counselor | 1517 Nicholasville Rd Ste 402, Lexington, KY 40503 | 2018-01-29 |
| 1245748235 | Sherry Kay Adkins | Registered Nurse | Baptist Health Lexington 1740 Nicholasville Road, Diabetes Education, Lexington, KY 40503 | 2018-01-12 |
| 1003334780 | Martin Bennett Hundley | Counselor | 274 Southland Dr # 204, Lexington, KY 40503 | 2017-09-01 |
| Find all providers in zip 40503 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871593996 | Samuel J Pruden II | Dermatology | 989 Governors Ln Ste 220, Lexington, KY 40513-1175 | 2005-07-29 |
| 1457355174 | John L Buker | Dermatology | 3475 Richmond Rd, Ste 200, Lexington, KY 40509-2500 | 2005-06-10 |
| 1003133901 | Joseph Allen Blackmon | Dermatology | 2424 Harrodsburg Rd Ste 200, Lexington, KY 40503 | 2010-05-01 |
| 1609924018 | Buker Office Based Surgery, Pllc | Dermatology | 3475 Richmond Rd, Suite 200, Lexington, KY 40509-2500 | 2007-01-08 |
| 1992701320 | Dermatology Consultants, Psc | Dermatology | 2424 Harrodsburg Rd, Suite 200, Lexington, KY 40503-2106 | 2005-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821435074 | Robert Louis Skaggs II | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2013-05-29 |
| 1326203142 | Dermatology of Southern Kentucky Pllc | Dermatology | 85 Tower Cir, Somerset, KY 42503-3476 | 2008-07-21 |
| 1740315589 | Jack Foster Ditty Jr. | Dermatology | 100 Saint Christopher Dr, Ashland, KY 41101-7016 | 2007-02-22 |
| 1902302987 | Kentucky Skin Cancer Center Pllc | Dermatology | 1818 Wallace Court, Suite 301, Bowling Green, KY 42103 | 2018-03-30 |
| 1477922672 | Forefront Dermatology, S.c. | Dermatology | 2333 Ring Rd, Elizabethtown, KY 42701 | 2015-09-17 |
| 1861897217 | Forefront Dermatology, S.c. | Dermatology | 501 S 2nd St, Louisville, KY 40202 | 2014-10-28 |
| 1932132768 | Dermatology and Skin Cancer Specialists, Psc | Dermatology | 2200 E Parrish Ave, Bldg E Suite 205, Owensboro, KY 42303-1449 | 2006-07-07 |
| 1114969201 | Johnathon Curtis Edge | Dermatology | 2200 E Parrish Ave, Bldg E Suite 205, Owensboro, KY 42303-1449 | 2006-06-12 |
| 1134112808 | Scott Andrew Neltner | Dermatology | 2701 Chancellor Dr, Crestview Hills, KY 41017-5479 | 2005-08-26 |
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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.