SHAVON PRENTICE (NPI# 1962782128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962782128 |
| Entity Type | Individual |
| Full Name | SHAVON PRENTICE |
| Credential | APRN |
| Practice Address |
828 Lane Allen Rd Ste 219 Lexington KY 40504 |
| Mailing Address |
Po Box 3299 Carson City NV 89702-3299 |
| Practice Telephone | 5024984071 |
| Practice Fax Number | 8884235216 |
| Mailing Telephone | 7752220044 |
| Mailing Fax Number | 8887000187 |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2018-07-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71003614A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
3007023 | KY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 7100200290 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2100 Millvale Rd, Louisville, KY 402051604 | 5024510990 | 5024591018 |
| Street Address |
828 LANE ALLEN RD STE 219 |
| City | LEXINGTON |
| State | KY |
| Zip Code | 40504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871550913 | Ellen Thomson | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2006-05-01 |
| 1780297994 | Relymd Medical Group Ky, LLC | Family Medicine | 828 Lane Allen Rd Ste 219, Lexington, KY 40504-3659 | 2020-08-26 |
| 1790146926 | Kathleen J. Short | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2016-03-16 |
| 1881087658 | Christopher Bush | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504-3659 | 2015-03-18 |
| 1225479637 | Victoria Olufunmilola Agbola | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2013-07-13 |
| 1508120502 | Terry L Cable | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2012-06-25 |
| 1770899403 | Genny Patricia Sanders | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504-3659 | 2010-08-18 |
| 1598094013 | Ami Elizabeth Bostic | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2009-12-11 |
| 1053507798 | Lisa Carole Primm | Nurse Practitioner | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2007-09-17 |
| 1942415732 | Achamma S Itticheria | Family Medicine | 828 Lane Allen Rd Ste 219, Lexington, KY 40504 | 2007-05-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740809953 | Michael Jason Blocker | Registered Nurse | 1 St Hoseph Drive, Lexington, KY 40504 | 2020-04-09 |
| 1841842010 | Jessica Brooke Castleberry | Counselor | Chrysalis House, Inc., 1589 Hill Rise Drive, Lexington, KY 40504 | 2019-07-09 |
| 1528554474 | Hillcrest Pain & Spine Pllc | Pain Medicine | 853 Lane Allen Rd Ste 217, Lexington, KY 40504 | 2018-07-03 |
| 1366962474 | Jessica Hope King | Dentist | 1330 Harrodsburg Road, Lexington, KY 40504 | 2017-06-21 |
| 1255861076 | Mary Elizabeth Bailey | Dentist | 1330 Harrodsburg Rd, Lexington, KY 40504 | 2017-06-14 |
| 1295172211 | Alan Kidon | Podiatrist | 1401 Harrodsburg Rd Ste C115, Lexington, KY 40504 | 2013-05-31 |
| 1578847554 | Linda W Mcdaniel | Pharmacist | 2181 Harrodsburg Road, Lexington, KY 40504 | 2011-10-07 |
| 1578844197 | Amber Kincaid Ballard | Nurse Practitioner | Uk Healthcare Team Blue Primary Care Clinic, 2400 Great Stone Point, Lexington, KY 40504 | 2011-09-09 |
| 1104118124 | Harry W Tenfelde IIi | Pharmacist | 2284 Versailles Rd., Lexington, KY 40504 | 2011-05-10 |
| 1831495506 | Horizon Headache Center, Pllc | Physical Therapist | 2365 Harrodsburg Road, Suite B-100, Lexington, KY 40504 | 2011-01-28 |
| Find all providers in zip 40504 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184225161 | Christina Chan Sok | Nurse Practitioner | 24 Hartwell Ave # 204, Lexington, MA 02421-3132 | 2020-11-05 |
| 1871194381 | Stacie Rose | Nurse Practitioner | 131 Hartwell Ave, Lexington, MA 02421-3105 | 2020-11-03 |
| 1952900870 | Sarah Elizabeth Clark | Nurse Practitioner | 1309 Morning Side Ct, Lexington, KY 40509-2353 | 2020-10-21 |
| 1629677745 | Lisa Elaine Coleman | Nurse Practitioner | 2241 Gulfstream Dr, Lexington, KY 40504-3273 | 2020-10-20 |
| 1578161303 | Mariem Kader | Nurse Practitioner | 3622 White Pine Dr, Lexington, KY 40514-1740 | 2020-10-14 |
| 1023616125 | Kimberly Dawn Calloway | Nurse Practitioner | 5306 E Blocher Rd, Lexington, IN 47138-8803 | 2020-10-12 |
| 1649878992 | Margaret Bunch | Nurse Practitioner | 171 W Lowry Ln Ste 132, Lexington, KY 40503-3006 | 2020-10-09 |
| 1831701572 | Jillian Leigh Butcher | Nurse Practitioner | 2917 Mahala Ln, Lexington, KY 40509-8555 | 2020-08-22 |
| 1033721154 | Heart Rescue Cpr LLC | Nurse Practitioner | 501 Darby Creek Rd Ste 18, Lexington, KY 40509-1606 | 2020-08-19 |
| 1619588241 | Jordyn L Bush | Nurse Practitioner | 124 Clay Ave, Lexington, KY 40502-1702 | 2020-08-17 |
| 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.