MEDICARE: KEVIN LEWIS LAWSON KPSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	1204107	KY

General Provider Information

NPI Number	:	1528783461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN LEWIS LAWSON KPSS

Provider Business Mailing Address
First Line	:	6593 KY 910
Second Line	:
City	:	WINDSOR
State	:	KY
Zip	:	42565-6045
Country	:	US
Telephone Number	:	270-572-0856
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 BARDSTOWN RD
Second Line	:
City	:	ST CATHARINE
State	:	KY
Zip	:	40061-9435
Country	:	US
Telephone Number	:	833-745-1020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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