Kentucky Mountain Emergency Physicians

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

KENTUCKY MOUNTAIN EMERGENCY PHYSICIANS

Practice address

5000 Ky Route 321
Prestonsburg, KY 41653-9113

Phone

(606) 886-8511

NPI assigned

Jul 17, 2007

Last updated

Jul 17, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer Provasnik

Title

Supervisor of Provider Enrollment

Phone

(800) 355-0808

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1336348523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42966",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191012966",
            "telephone_number": "800-355-0808",
            "fax_number": "610-834-2862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 KY ROUTE 321",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416539113",
            "telephone_number": "606-886-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY MOUNTAIN EMERGENCY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "PROVASNIK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "SUPERVISOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "800-355-0808"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000000332890",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65943375",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Logan Kennedy
• Mary Kennedy
• Sarah Kenniston
• Kentucky Em-I Medical Services, PSC
• Kentucky Laparoscopic & Advanced Surgical Specialists, PLLC
• Kentucky Pain Physicians (Robert E Windsor MD)
• Kentucky Pain Physicians, PSC
• Kentucky Phoenix Project LLC
• Kentucky Surgical Arts PSC
• Heather Kestner

• Emergency Medicine Physician in Prestonsburg, KY
• Providers in Prestonsburg, KY by specialty
• Emergency Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.