Keenan James Pacut

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

410 E Church St
Fort Valley, GA 31030-3097

Phone

(229) 938-7274

NPI assigned

Feb 18, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1013540160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E CHURCH ST",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310303097",
            "telephone_number": "229-938-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E CHURCH ST",
            "city": "FORT VALLEY",
            "state": "GA",
            "postal_code": "310303097",
            "telephone_number": "229-938-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACUT",
        "first_name": "KEENAN",
        "middle_name": "JAMES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "keenanp@mfbhc.org",
            "affiliation": "N",
            "endpointDescription": "Work E-Mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Work",
            "address_1": "410 E Church St",
            "city": "Fort Valley",
            "state": "GA",
            "country_code": "US",
            "postal_code": "310303097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Moore
• Robert L. Nelson, M.D.
• Jonathan B O'Connor, PHARM. D
• Belinda Marshelle Oates, MS
• Anna Omachonu
• Rachna Patel, MD
• Peach Center
• Peach County Association for the M.R. Inc
• Peach County Board of Commissioners
• Peach County Board of Health

• Community/Behavioral Health Agency in Fort Valley, GA
• Providers in Fort Valley, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.