Paducah Dermatology PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

32680 Issued in KY

Legal business name

PADUCAH DERMATOLOGY PLLC

Practice address

3101 Parisa Dr
Paducah, KY 42003

Phone

(270) 444-8477

Fax

(270) 444-8479

NPI assigned

Jan 18, 2007

Last updated

Aug 8, 2018By 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

Halden Heath Ford, MDNPI 1396747846

Title

Owner

Phone

(270) 444-8477

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY, TN2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Halden H Ford, M.D.

  • Dermatology Physician
  • Paducah, KY
  • NPI 1396747846

  TN

  Medicare reassignment Care Compare group NPD Authorized official
• Joseph Allen Blackmon, M.D.

  • MOHS-Micrographic Surgery Physician
  • Paducah, KY
  • NPI 1003133901
  Medicare reassignment Care Compare group NPD
• Tanya Christine Cobb, APRN

  • Family Nurse Practitioner
  • Paducah, KY
  • NPI 1457904526
  Medicare reassignment Care Compare group NPD
• Brittany Nicole Wrather, APRN

  • Family Nurse Practitioner
  • Paducah, KY
  • NPI 1568148567
  Medicare reassignment Care Compare group NPD
• Christy O'Bryan Hart, APRN

  • Family Nurse Practitioner
  • Paducah, KY
  • NPI 1861615106
  Medicare reassignment Care Compare group
• Tyler E Hatchell, PA-C

  • Physician Assistant
  • Paducah, KY
  • NPI 1477846517

  TN

  Medicare reassignment Care Compare group
• Carly Unger Herrin, PA

  • Physician Assistant
  • Paducah, KY
  • NPI 1487109930

  TN

  Medicare reassignment Care Compare group
• Abigail Marie Murt, PA-C

  • Physician Assistant
  • Paducah, KY
  • NPI 1396501276
  Medicare reassignment Care Compare group
• Natalie Adams Travis

  • Physician Assistant
  • Murray, KY
  • NPI 1154063774
  Medicare reassignment Care Compare group
• Madison Kate Wagner

  • Physician Assistant
  • Paducah, KY
  • NPI 1578256103
  Medicare reassignment Care Compare group
• Tina Kelly, MSN, FNP-C

  • Family Nurse Practitioner
  • Union City, TN
  • NPI 1871277285
  Medicare reassignment NPD
• Cooper Campbell Wriston, MD

  • Dermatology Physician
  • Burlington, VT
  • NPI 1134356728

  TN

  Medicare reassignment NPD

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533686400000",
    "number": "1831242551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 PARISA DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420034584",
            "telephone_number": "270-444-8477",
            "fax_number": "270-444-8479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 PARISA DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "42003",
            "telephone_number": "270-444-8477",
            "fax_number": "270-444-8479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PADUCAH DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2018-08-08",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "HALDEN",
        "authorized_official_middle_name": "HEATH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-444-8477",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "KY",
            "license": "32680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65940298",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janine Owens, PT,DPT
• Mark L Owens, O.D.
• Paducah Area Physicisns, Inc
• Paducah Center for Health and Rehabilitation, LLC (Stonecreek Health And Rehabilitation)
• Paducah Chiropractic Center, PSC
• Paducah Dermatology Surgery Center PLLC
• Paducah Gastroenterology Associates, PSC
• Paducah Gastroenterology Associates, PSC
• Paducah Health Facilities LP (McCracken Nursing and Rehabilitation Center)
• Paducah Health Services, LLC (Paducah Centre)

• Dermatology Physician in Paducah, KY
• Providers in Paducah, KY by specialty
• Dermatology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.