Individual provider Active NPI

Pathrusim Levi Keaffaber, CNP

  • Nurse Practitioner
  • Prestonsburg, KY
National Provider Identifier
1225993223
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4049598 Issued in KY
Practice address
5000 Ky-321
Prestonsburg, KY 41653
Phone
(606) 886-8511
NPI assigned
Dec 22, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 82693 WV
Nurse Practitioner 363L00000X 4049598 KY Primary

Addresses

Primary practice location

5000 Ky-321
Prestonsburg, KY 41653

Mailing address

5000 Ky-321
Prestonsburg, KY 41653

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20260224003566 WV Practitioner - Nurse Practitioner 8426539859 Reassigns benefits to 1 organization
I20260302002440 KY Practitioner - Nurse Practitioner 8426539859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Lafayette, LA 70505

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4049598KYMDNurse Practitioner
82693WVMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Green Valley Emergency Physicians, LLC Nurse Practitioner CurrentSince Feb 19, 2026 Accepting new patients
Richbend Emergency Physicians, PLLC Nurse Practitioner CurrentSince Feb 19, 2026 Accepting new patients

Locations

5000 Ky Route 321
Prestonsburg, KY 41653
Phone (606) 886-7645

306 Stanaford Rd
Beckley, WV 25801
Phone (304) 255-3373

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1766361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766361600000",
    "number": "1225993223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 KY-321",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "41653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 KY-321",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "41653",
            "telephone_number": "606-886-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEAFFABER",
        "first_name": "PATHRUSIM",
        "middle_name": "LEVI",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-22",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "82693",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "4049598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.