Active NPI
Gillian Jerleen Phelps, CSFA
- Surgical Technologist
- Somerset, KY
National Provider Identifier
1619754637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- TSA057
- Practice address
- 305 Langdon St
Somerset, KY 42503-2750 - Phone
- (606) 679-7441
- NPI assigned
- Sep 12, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | TSA057 | KY | Primary |
Addresses
Primary practice location
305 Langdon St
Somerset, KY 42503-2750
Mailing address
74 Hermosa Dr
Somerset, KY 42503-5652
Phone (704) 775-6762
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TSA057 | KY | MD | Surgical Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake City Surgical Assistants LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Surgical Assistant
- Somerset, KY
- NPI 1831896562
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1694476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1619754637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74 HERMOSA DR",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425035652",
"telephone_number": "704-775-6762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 LANGDON ST",
"city": "SOMERSET",
"state": "KY",
"postal_code": "425032750",
"telephone_number": "606-679-7441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHELPS",
"first_name": "GILLIAN",
"middle_name": "JERLEEN",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-12",
"last_updated": "2023-09-12",
"certification_date": "2023-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "KY",
"license": "TSA057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerset, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.