Provision Home

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Legal business name

PROVISION HOME

Practice address

778 Broadway St
West Liberty, KY 41472-1110

Phone

(606) 923-0361

NPI assigned

Jan 15, 2024

Organization subpart

No

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

Authorized official

Name

David Brian Bartley, APSS

Title

Director

Phone

(606) 923-0361

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1705276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705276800000",
    "number": "1730950072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "778 BROADWAY ST",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414721110",
            "telephone_number": "606-923-0361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "778 BROADWAY ST",
            "city": "WEST LIBERTY",
            "state": "KY",
            "postal_code": "414721110",
            "telephone_number": "606-923-0361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-15",
        "last_updated": "2024-01-15",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "BARTLEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "606-923-0361",
        "authorized_official_credential": "APSS"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydia Phipps, APRN
• Amanda Pieratt
• Sarah Porter
• Elizabeth Potter, ARNP
• Irene Powell
• Candice Ratliff
• Shateka Ratliff
• Stacy Lynn Ritchie, PT
• Robert L. Henderson, D.M.D PSC
• Tara Rohr

• Peer Specialist in West Liberty, KY
• Providers in West Liberty, KY by specialty
• Peer Specialist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; 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.