1073543245 NPI number — PEYTON HEWITT TURNER PAC

Table of content: MS. MARY V THOMAS-PRESSLEY APN-C (NPI 1174719751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073543245 NPI number — PEYTON HEWITT TURNER PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNER
Provider First Name:
PEYTON
Provider Middle Name:
HEWITT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNER
Provider Other First Name:
PEYTON
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073543245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 STANLEY GAULT PKWY STE 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-5176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-489-6613
Provider Business Mailing Address Fax Number:
502-489-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 KRESGE WAY
Provider Second Line Business Practice Location Address:
SUITE 46
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-899-3858
Provider Business Practice Location Address Fax Number:
502-899-3878
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA948 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA948 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00408681 . This is a "RRMCR - CTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000501586 . This is a "ANTHEM - CTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50014938 . This is a "PASSPORT - CTS 560" identifier . This identifiers is of the category "OTHER".
  • Identifier: 084618 . This is a "SIHO - CTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95006110 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2846541000 . This is a "PAD - CTS 560" identifier . This identifiers is of the category "OTHER".




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