Individual provider Active NPI

Kent F. Williams, PHARMD.

  • Pharmacist
  • Elizabethtown, KY
National Provider Identifier
1275603128
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
012058 Issued in KY
Practice address
2415 Ring Rd.
Elizabethtown, KY 42701-7064
Phone
(270) 765-2157
Fax
(270) 765-2357
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 012058 KY Primary

Addresses

Primary practice location

2415 Ring Rd.
Elizabethtown, KY 42701-7064

Mailing address

2415 Ring Rd
Elizabethtown, KY 42701-7941

Other identifiers 1

IdentifierTypeStateIssuer
012058OtherKYPHARMACIST LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
012058KYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
LJB Inc CurrentSince Oct 30, 2022 Accepting new patients
Optimal Health Clinical LLC CurrentSince Jul 2, 2023 Accepting new patients
LJB Inc CurrentSince Oct 30, 2022 Accepting new patients

Locations

2415 Ring Rd
Ste 100
Elizabethtown, KY 42701
Phone (270) 765-2157

2415 Ring Rd
Elizabethtown, KY 42701
Phone (270) 765-2157

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1275603128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2415 RING RD",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2415 RING RD.",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017064",
            "telephone_number": "270-765-2157",
            "fax_number": "270-765-2357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KENT",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "PHARMD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "KY",
            "license": "012058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "012058",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.