Provider Demographics
NPI:1205819927
Name:PEPPER, PATRICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:PEPPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE B-275
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-2334
Practice Address - Fax:859-278-0159
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2019-08-09
Deactivation Date:2005-11-28
Deactivation Code:
Reactivation Date:2005-12-13
Provider Licenses
StateLicense IDTaxonomies
KYPA008363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005047Medicaid
R61866Medicare UPIN
KY970000275Medicare PIN
KY0028118Medicare PIN