Healthcare Provider Details

I. General information

NPI: 1205819927
Provider Name (Legal Business Name): PATRICK PEPPER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date: 11/28/2005
Reactivation Date: 12/13/2005

III. Provider practice location address

1401 HARRODSBURG RD SUITE B-275
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-2334
  • Fax: 859-278-0159
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA008
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: