Provider Demographics
NPI:1073543245
Name:TURNER, PEYTON HEWITT (PAC)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:HEWITT
Last Name:TURNER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:PEYTON
Other - Middle Name:H
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-489-6613
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 46
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-899-3858
Practice Address - Fax:502-899-3878
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA948363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00408681OtherRRMCR - CTS
000000501586OtherANTHEM - CTS
50014938OtherPASSPORT - CTS 560
084618OtherSIHO - CTS
KY95006110Medicaid
2846541000OtherPAD - CTS 560
KY0998865Medicare UPIN
50014938OtherPASSPORT - CTS 560